Provider Demographics
NPI:1932709433
Name:CHILDREN'S CENTER FOR DENTISTRY
Entity Type:Organization
Organization Name:CHILDREN'S CENTER FOR DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MACKENZIE
Authorized Official - Middle Name:
Authorized Official - Last Name:STARKEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:309-827-5437
Mailing Address - Street 1:314 SUSAN DR
Mailing Address - Street 2:
Mailing Address - City:NORMAL
Mailing Address - State:IL
Mailing Address - Zip Code:61761-6206
Mailing Address - Country:US
Mailing Address - Phone:309-827-5437
Mailing Address - Fax:309-265-0288
Practice Address - Street 1:314 SUSAN DR
Practice Address - Street 2:
Practice Address - City:NORMAL
Practice Address - State:IL
Practice Address - Zip Code:61761-6206
Practice Address - Country:US
Practice Address - Phone:309-827-5437
Practice Address - Fax:309-265-0288
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-26
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty