|
| |
|
2220 S. State Route 157 Suite 125 Glen Carbon IL 62034-1728 | |
| (618) 288-0600 | |
| (618) 288-8004 |
| Full Name | |
|---|---|
| Speciality | Dentist - Orthodontics And Dentofacial Orthopedics |
| Location | 2220 S. State Route 157, Glen Carbon, Illinois |
| Authorized Official Name and Position | Jeffrey S. Mastroianni (DR) |
| Authorized Official Contact | 6182880600 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
2220 S. State Route 157 Suite 125 Glen Carbon IL 62034-1728 Ph: (618) 288-0600 | 2220 S. State Route 157 Suite 125 Glen Carbon IL 62034-1728 Ph: (618) 288-0600 |
| NPI Number | 1528187549 |
|---|---|
| Provider Enumeration Date | 03/29/2007 |
| Last Update Date | 10/24/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1528187549 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223X0400X | Dentist - Orthodontics And Dentofacial Orthopedics | 019024812 (Illinois) | Primary |
Ginger Creek Dental Llc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 24 Ginger Creek Pkwy, Glen Carbon, IL 62034 Phone: 618-692-1110 | |
West End Family Dental Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 24 Ginger Creek Pkwy, Glen Carbon, IL 62034 Phone: 618-692-1110 | |
St. Louis Surgical Associates, Llc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 24 Ginger Creek Pkwy, Glen Carbon, IL 62034 Phone: 618-655-1580 | |
Kellerman Dental Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 16 Junction Dr W Ste 101, Glen Carbon, IL 62034 Phone: 618-288-3535 | |