Organization · Type 2 NPI
Edwardsville Family Dentist
Dental Clinic/Center · Edwardsville, IL
NPI number
1063899417
Active
Practice location
1811 Lindenwood Ave
Edwardsville, IL 62025-2580
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Dental Clinic/Center Primary | 261QD0000X | 019028093 (IL) |
Dental Clinic/Center: Definition to come...
4 other providers at this address
Other dental clinic/center providers in Edwardsville
About NPI 1063899417
Edwardsville Family Dentist's National Provider Identifier is 1063899417, issued on May 5, 2015. The primary taxonomy on file is Dental Clinic/Center (261QD0000X), and the practice location is in Edwardsville, IL. The record was last updated on Jul 24, 2023.