is a Dental Clinic in Decatur, Illinois. It is located at 3737 Us Rt 36 E, Decatur, IL and its contact number is 217-423-2400. The authorized person for is Kelly Clark
who is Owner/president of the clinic and their contact number is 217-423-2400. The primary license number for is 060009717 (General Practice) in Illinois. Clinic caters to patients of all ages for their dental care needs. Dentists at the clinic are responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.
Complete Clinic Profile:
Clinic speciality, address, contact phone number and fax are as below.
Patients can call on the below given phone number for appointments.
Name:
Specialization:
General Practice Dentistry
Clinic Address:
3737 Us Rt 36 E, Decatur, Illinois, 62521
Phone:
217-423-2400
Authorized/Official Person Profile:
Officially authorized person to contact for any management issues or complaints for this clinic are as below. Person's position and contact details are also mentioned below.
Name:
Kelly Clark
Position:
Owner/president
Contact Number:
217-423-2400
Professional Identification Codes:
NPI number stands for National Provider Identifier which is a unique 10-digit identification number issued to health care providers in the United States by the Centers for Medicare and Medicaid Services (CMS).
NPI details for clinic are as mentioned below.
NPI Number:
1982839056
NPI Enumeration Date:
19 May, 2009
NPI Last Update On:
19 May, 2009
Medical Licenses:
Organizations can have one or more medical licenses for different specialities in the same state or different states. Related medical licenses for are as mentioned below.
Specialization
License Number
State
Status
General Practice
060009717
Illinois
Primary
Other Medical Identifiers:
Other legacy medical identifiers of the clinic such as Medicaid, Medicare PIN, NSC, UPIN etc. are mentioned as below.
Identifier
Type
State
Issuer
1073693883
Other
Illinois
Blue Cross
1700959020
Other
Illinois
Blue Cross
1801059100
Other
Illinois
Blue Cross
1942379458
Other
Illinois
Blue Cross
Business Mailing Address:
Business mailing address can be used for mailing purpose only, for visiting purpose patients need to refer above mentioned address.
Address:
3737 Us Rt 36 E, Decatur, Illinois
Zip:
62521
Phone Number:
217-423-2400
Patients can reach at 3737 Us Rt 36 E, Decatur, Illinois or can call to book an appointment on 217-423-2400. Data of this site is collected from Medicare & Medicaid Services (CMS) and NPPES. Last updated on 10 February, 2025.