|
| |
|
25 Glen Ed Professional Park Glen Carbon IL 62034-3333 | |
| (618) 692-6040 | |
| (618) 692-6081 |
| Full Name | |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 25 Glen Ed Professional Park, Glen Carbon, Illinois |
| Authorized Official Name and Position | Briana Leigh Oller (PRESIDENT/DENTIST) |
| Authorized Official Contact | 6185678487 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
6824 Deer Crk Edwardsville IL 62025-3060 Ph: (618) 567-8487 | 25 Glen Ed Professional Park Glen Carbon IL 62034-3333 Ph: (618) 692-6040 |
| NPI Number | 1770741183 |
|---|---|
| Provider Enumeration Date | 06/02/2008 |
| Last Update Date | 06/02/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1770741183 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 019026211 (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 | |