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1111 E Walnut St Ste B Carbondale IL 62901-5000 | |
| (618) 529-2571 | |
| (618) 529-2572 |
| Full Name | |
|---|---|
| Speciality | Dentist - Oral And Maxillofacial Surgery |
| Location | 1111 E Walnut St Ste B, Carbondale, Illinois |
| Authorized Official Name and Position | Billy B Laun (OWNER/PROVIDER) |
| Authorized Official Contact | 6185292571 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1111 E Walnut St Ste B Carbondale IL 62901-5000 Ph: () - | 1111 E Walnut St Ste B Carbondale IL 62901-5000 Ph: (618) 529-2571 |
| NPI Number | 1194381640 |
|---|---|
| Provider Enumeration Date | 05/09/2019 |
| Last Update Date | 09/11/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194381640 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | (* (Not Available)) | Primary |
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