Provider Demographics
NPI:1952829889
Name:MAURER FAMILY DENTAL LLC
Entity Type:Organization
Organization Name:MAURER FAMILY DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TRISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:FLUCKIGER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:217-546-8600
Mailing Address - Street 1:1526 S BATES AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62704-3348
Mailing Address - Country:US
Mailing Address - Phone:217-314-9317
Mailing Address - Fax:
Practice Address - Street 1:4526 OLD SALEM LN
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62711-6006
Practice Address - Country:US
Practice Address - Phone:217-546-8600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-30
Last Update Date:2017-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty