| Southern Illinois Pediatric Dentistry | |
|
1320 Columbia Ctr Columbia IL 62236-2561 | |
| (618) 719-2400 | |
| Not Available |
| Full Name | Southern Illinois Pediatric Dentistry |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 1320 Columbia Ctr, Columbia, Illinois |
| Authorized Official Name and Position | Christine Anne Wohlford (OWNER/MEMBER) |
| Authorized Official Contact | 6187912794 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Southern Illinois Pediatric Dentistry 1320 Columbia Ctr Columbia IL 62236-2561 Ph: (618) 719-2400 | Southern Illinois Pediatric Dentistry 1320 Columbia Ctr Columbia IL 62236-2561 Ph: (618) 719-2400 |
| NPI Number | 1821462052 |
|---|---|
| Provider Enumeration Date | 11/27/2015 |
| Last Update Date | 11/27/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1821462052 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | 019028314 (Illinois) | Primary |
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