Provider Demographics
NPI:1629191382
Name:PRINCETON FAMILY DENTISTRY, LTD
Entity Type:Organization
Organization Name:PRINCETON FAMILY DENTISTRY, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:MONROE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:815-223-6013
Mailing Address - Street 1:334 BACKBONE RD E
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:IL
Mailing Address - Zip Code:61356-9685
Mailing Address - Country:US
Mailing Address - Phone:815-875-1183
Mailing Address - Fax:815-879-2603
Practice Address - Street 1:334 BACKBONE RD E
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:IL
Practice Address - Zip Code:61356-9685
Practice Address - Country:US
Practice Address - Phone:815-875-1183
Practice Address - Fax:815-879-2603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty