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50 North Center Street East Alton IL 62024 | |
| (618) 259-5563 | |
| (618) 259-4074 |
| Full Name | |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 50 North Center Street, East Alton, Illinois |
| Authorized Official Name and Position | Amy Kroeger (INS COOD) |
| Authorized Official Contact | 2175405100 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
50 North Center Street East Alton IL 62024 Ph: (618) 259-5563 | 50 North Center Street East Alton IL 62024 Ph: (618) 259-5563 |
| NPI Number | 1184846628 |
|---|---|
| Provider Enumeration Date | 05/03/2007 |
| Last Update Date | 05/21/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1184846628 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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