Provider Demographics
NPI:1487875878
Name:MORTON DENTAL CENTER
Entity type:Organization
Organization Name:MORTON DENTAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:V. PRES.
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIKA
Authorized Official - Middle Name:K
Authorized Official - Last Name:GRIMM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:309-263-2781
Mailing Address - Street 1:1600 S 4TH AVE
Mailing Address - Street 2:STE 110
Mailing Address - City:MORTON
Mailing Address - State:IL
Mailing Address - Zip Code:61550-2889
Mailing Address - Country:US
Mailing Address - Phone:309-263-2781
Mailing Address - Fax:309-263-4161
Practice Address - Street 1:1600 S 4TH AVE
Practice Address - Street 2:STE 110
Practice Address - City:MORTON
Practice Address - State:IL
Practice Address - Zip Code:61550-2889
Practice Address - Country:US
Practice Address - Phone:309-263-2781
Practice Address - Fax:309-263-4161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty