| Edwardsville Family Dentist | |
|
1811 Lindenwood Ave Edwardsville IL 62025-2580 | |
| (618) 659-0456 | |
| Not Available |
| Full Name | Edwardsville Family Dentist |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 1811 Lindenwood Ave, Edwardsville, Illinois |
| Authorized Official Name and Position | Beau G Moody (DENTIST/OWNER) |
| Authorized Official Contact | 6186590456 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Edwardsville Family Dentist 1811 Lindenwood Ave Edwardsville IL 62025-2580 Ph: (618) 659-0456 | Edwardsville Family Dentist 1811 Lindenwood Ave Edwardsville IL 62025-2580 Ph: (618) 659-0456 |
| NPI Number | 1063899417 |
|---|---|
| Provider Enumeration Date | 05/05/2015 |
| Last Update Date | 07/24/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063899417 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | 019028093 (Illinois) | Primary |
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