| Lincoln Place Dental Pc | |
|
114 Lincoln Place Ct Belleville IL 62221-5884 | |
| (618) 257-9189 | |
| (618) 257-9253 |
| Full Name | Lincoln Place Dental Pc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 114 Lincoln Place Ct, Belleville, Illinois |
| Authorized Official Name and Position | Gerald Wayne Dortch (OWNER) |
| Authorized Official Contact | 6182579189 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lincoln Place Dental Pc 114 Lincoln Place Ct Belleville IL 62221-5884 Ph: (618) 257-9189 | Lincoln Place Dental Pc 114 Lincoln Place Ct Belleville IL 62221-5884 Ph: (618) 257-9189 |
| NPI Number | 1417221532 |
|---|---|
| Provider Enumeration Date | 03/07/2012 |
| Last Update Date | 03/07/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417221532 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 019016287 (Illinois) | Primary |
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