| Southern Illinois Pediatric Dentistry Of Edwardsville | |
|
1419 Lewis Road Suite 2 Edwardsville IL 62025 | |
| (618) 655-3272 | |
| (618) 655-3273 |
| Full Name | Southern Illinois Pediatric Dentistry Of Edwardsville |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 1419 Lewis Road, Edwardsville, Illinois |
| Authorized Official Name and Position | Christine Anne Wohlford (DENTIST/MEMBER) |
| Authorized Official Contact | 6186553272 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Southern Illinois Pediatric Dentistry Of Edwardsville 1419 Lewis Road Suite 2 Edwardsville IL 62025 Ph: (618) 655-3272 | Southern Illinois Pediatric Dentistry Of Edwardsville 1419 Lewis Road Suite 2 Edwardsville IL 62025 Ph: (618) 655-3272 |
| NPI Number | 1568925014 |
|---|---|
| Provider Enumeration Date | 04/11/2019 |
| Last Update Date | 04/11/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568925014 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | (* (Not Available)) | Primary |
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