| St Louis Dental Implant Group | |
|
3750 Green Mount Crossing Dr Shiloh IL 62269 | |
| (314) 729-7840 | |
| Not Available |
| Full Name | St Louis Dental Implant Group |
|---|---|
| Speciality | Dentist |
| Location | 3750 Green Mount Crossing Dr, Shiloh, Illinois |
| Authorized Official Name and Position | Mark Alan Mangels (OWNER) |
| Authorized Official Contact | 6369700295 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| St Louis Dental Implant Group 11222 Tesson Ferry Rd Saint Louis MO 63123-6963 Ph: (314) 729-7840 | St Louis Dental Implant Group 3750 Green Mount Crossing Dr Shiloh IL 62269 Ph: (314) 729-7840 |
| NPI Number | 1447424668 |
|---|---|
| Provider Enumeration Date | 04/18/2008 |
| Last Update Date | 04/18/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1447424668 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | (Illinois) | Primary |
| 1223P0300X | Dentist - Periodontics | (Illinois) | Secondary |
Shiloh Dental Group Llc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 301 Tamarack Ln, Shiloh, IL 62269 Phone: 618-643-9523 |