| Periodontics Of Southern Illinois | |
|
#11 Park Place Belleville IL 62226-2925 | |
| (618) 233-7300 | |
| (618) 233-7432 |
| Full Name | Periodontics Of Southern Illinois |
|---|---|
| Speciality | Dentist - Periodontics |
| Location | #11 Park Place, Belleville, Illinois |
| Authorized Official Name and Position | Josepj A Renner (OWNER) |
| Authorized Official Contact | 6182337300 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Periodontics Of Southern Illinois #11 Park Place Belleville IL 62226-2925 Ph: (618) 233-7300 | Periodontics Of Southern Illinois #11 Park Place Belleville IL 62226-2925 Ph: (618) 233-7300 |
| NPI Number | 1639224876 |
|---|---|
| Provider Enumeration Date | 01/25/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1639224876 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0300X | Dentist - Periodontics | (Illinois) | Primary |
| 1223P0300X | Dentist - Periodontics | (Illinois) | Secondary |
| 1223P0300X | Dentist - Periodontics | (Illinois) | Secondary |
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