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1490 North Greenmount Road Suite B Ofallon IL 62269 | |
(618) 632-1603 | |
(618) 632-6034 |
Full Name | |
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Speciality | Dentist - General Practice |
Location | 1490 North Greenmount Road, Ofallon, 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 |
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1490 North Greenmount Road Suite B Ofallon IL 62269 Ph: (618) 632-1603 | 1490 North Greenmount Road Suite B Ofallon IL 62269 Ph: (618) 632-1603 |
NPI Number | 1851513238 |
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Provider Enumeration Date | 05/03/2007 |
Last Update Date | 05/21/2008 |
Identifier | Type | State | Issuer |
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1851513238 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |