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105 Regency Park Suite 2 Ofallon IL 62269 | |
| (618) 628-1646 | |
| (618) 628-1643 |
| Full Name | |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 105 Regency Park, Ofallon, Illinois |
| Authorized Official Name and Position | Lindsay Bearden (INS COOD) |
| Authorized Official Contact | 2175405100 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
105 Regency Park Suite 2 Ofallon IL 62269 Ph: (618) 628-1646 | 105 Regency Park Suite 2 Ofallon IL 62269 Ph: (618) 628-1646 |
| NPI Number | 1447472709 |
|---|---|
| Provider Enumeration Date | 05/03/2007 |
| Last Update Date | 01/08/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1447472709 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |