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826 W Lincoln Suite B Charleston IL 61920 | |
| (217) 345-5250 | |
| (217) 345-5390 |
| Full Name | |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 826 W Lincoln, Charleston, 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 |
|---|---|
826 W Lincoln Suite B Charleston IL 61920 Ph: (217) 345-5250 | 826 W Lincoln Suite B Charleston IL 61920 Ph: (217) 345-5250 |
| NPI Number | 1245443514 |
|---|---|
| Provider Enumeration Date | 05/07/2007 |
| Last Update Date | 05/21/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1245443514 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |