Provider Demographics
NPI:1689891418
Name:PLAZA DENTAL CARE,LLC
Entity Type:Organization
Organization Name:PLAZA DENTAL CARE,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:HELLIGE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:618-654-7461
Mailing Address - Street 1:1001 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:IL
Mailing Address - Zip Code:62249-1901
Mailing Address - Country:US
Mailing Address - Phone:618-654-7461
Mailing Address - Fax:618-654-8032
Practice Address - Street 1:1001 BROADWAY
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:IL
Practice Address - Zip Code:62249-1901
Practice Address - Country:US
Practice Address - Phone:618-654-7461
Practice Address - Fax:618-654-8032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty