| Midwest Family Dentistry Pc | |
|
3120 Maryville Rd Granite City IL 62040-5119 | |
| (618) 797-9940 | |
| Not Available |
| Full Name | Midwest Family Dentistry Pc |
|---|---|
| Speciality | Dentist |
| Location | 3120 Maryville Rd, Granite City, Illinois |
| Authorized Official Name and Position | Laney Elayne Schuman-boys (PRESIDENT) |
| Authorized Official Contact | 6187979940 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Midwest Family Dentistry Pc 3120 Maryville Rd Granite City IL 62040-5119 Ph: (618) 797-9940 | Midwest Family Dentistry Pc 3120 Maryville Rd Granite City IL 62040-5119 Ph: (618) 797-9940 |
| NPI Number | 1558484410 |
|---|---|
| Provider Enumeration Date | 04/07/2007 |
| Last Update Date | 08/11/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1558484410 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 019-023663 (Illinois) | Primary |
| 332BC3200X | Durable Medical Equipment & Medical Supplies - Customized Equipment | (* (Not Available)) | Secondary |
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