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Organization · Orthodontics and Dentofacial Orthopedics Dentistry · O Fallon, IL

NPI
1669778601
Type
Organization (Type 2)
Primary specialty
Orthodontics and Dentofacial Orthopedics Dentistry (Dentist)
Specialty group
Dental Providers
Taxonomy code
1223X0400X
License number
060.009554 (IL)
Enumerated
2011-02-09
Last updated
2011-02-09
Practice location
741 W State St, Suite # 2
O Fallon, IL 62269-1971
(618) 624-0800

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