| Fairview Heights Dentistry | |
|
6407 N Illinois St Fairview Heights IL 62208-2720 | |
| (618) 310-0263 | |
| (618) 212-9054 |
| Full Name | Fairview Heights Dentistry |
|---|---|
| Speciality | Dentist |
| Location | 6407 N Illinois St, Fairview Heights, Illinois |
| Authorized Official Name and Position | Bryan K Watanabe (OWNER) |
| Authorized Official Contact | 6183100263 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Fairview Heights Dentistry Po Box 920050 Dallas TX 75392-0050 Ph: (714) 845-8500 | Fairview Heights Dentistry 6407 N Illinois St Fairview Heights IL 62208-2720 Ph: (618) 310-0263 |
| NPI Number | 1811558208 |
|---|---|
| Provider Enumeration Date | 06/26/2019 |
| Last Update Date | 03/08/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1811558208 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | (* (Not Available)) | Primary |
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