Provider Demographics
NPI:1972991032
Name:STEINWEDEL DENTAL ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:STEINWEDEL DENTAL ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:STEINWEDEL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:309-693-2232
Mailing Address - Street 1:2425 W CORNERSTONE CT
Mailing Address - Street 2:SUITE B
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61614-2494
Mailing Address - Country:US
Mailing Address - Phone:309-693-2232
Mailing Address - Fax:309-693-3796
Practice Address - Street 1:2425 W CORNERSTONE CT
Practice Address - Street 2:SUITE B
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61614-2494
Practice Address - Country:US
Practice Address - Phone:309-693-2232
Practice Address - Fax:309-693-3796
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-24
Last Update Date:2014-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty