| Collinsville Pediatric Dentistry Pllc | |
|
90 Crestmoor St Collinsville IL 62234-4951 | |
| (618) 346-8000 | |
| Not Available |
| Full Name | Collinsville Pediatric Dentistry Pllc |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 90 Crestmoor St, Collinsville, Illinois |
| Authorized Official Name and Position | Corey Hastings (OWNER/DENTIST) |
| Authorized Official Contact | 6183468000 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Collinsville Pediatric Dentistry Pllc 90 Crestmoor St Collinsville IL 62234-4951 Ph: (618) 346-8000 | Collinsville Pediatric Dentistry Pllc 90 Crestmoor St Collinsville IL 62234-4951 Ph: (618) 346-8000 |
| NPI Number | 1295366896 |
|---|---|
| Provider Enumeration Date | 02/01/2020 |
| Last Update Date | 02/01/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1295366896 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | (* (Not Available)) | Primary |
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