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101 United Dr Ste 150 Collinsville IL 62234-7439 | |
| (618) 345-7676 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Dentist |
| Location | 101 United Dr Ste 150, Collinsville, Illinois |
| Authorized Official Name and Position | Courtney Monteith (CREDENTIALING COORDINATOR) |
| Authorized Official Contact | 2145408306 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
101 United Dr Ste 150 Collinsville IL 62234-7439 Ph: () - | 101 United Dr Ste 150 Collinsville IL 62234-7439 Ph: (618) 345-7676 |
| NPI Number | 1235876814 |
|---|---|
| Provider Enumeration Date | 05/16/2022 |
| Last Update Date | 07/14/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1235876814 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | (* (Not Available)) | Primary |
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