| Maryville Family Dental | |
|
2921 North Center Street Suite 8-9 Maryville IL 62062 | |
| (618) 288-7804 | |
| (618) 288-7918 |
| Full Name | Maryville Family Dental |
|---|---|
| Speciality | Dentist |
| Location | 2921 North Center Street, Maryville, Illinois |
| Authorized Official Name and Position | Amanda Henderson (ACCOUNTS PAYABLE) |
| Authorized Official Contact | 6182886201 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Maryville Family Dental 26 Ginger Creek Pkwy Po Box 430 Glen Carbon IL 62034-3502 Ph: (618) 288-6201 | Maryville Family Dental 2921 North Center Street Suite 8-9 Maryville IL 62062 Ph: (618) 288-7804 |
| NPI Number | 1639405731 |
|---|---|
| Provider Enumeration Date | 10/23/2009 |
| Last Update Date | 10/08/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1639405731 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | (Illinois) | Primary |
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