# ASSOCIATED PEDIATRIC DENTISTRY, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1235527490
- **Authorized official:** DR. KEVIN C BEYERSDORFER (VICE PRESIDENT)
- **Authorized official phone:** (618) 622-0212

## Contact information

- **Practice address:** 4945 STONE FALLS CTR, SUITE B, O FALLON, IL 62269-7801
- **Practice address phone:** (618) 622-0212
- **Mailing address:** 4945 STONE FALLS CTR, SUITE B, O FALLON, IL 62269-7801
- **Mailing address phone:** (618) 622-0212

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223P0221X | Pediatric Dentistry | — | NULL | Yes |
| 1223P0221X | Pediatric Dentistry | — | — | Yes |

## Other

- **Enumeration date:** 12/22/2014
- **Last updated:** 12/22/2014