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Organization
SIGNATURE FAMILY DENTAL
Active
Organization
SIGNATURE FAMILY DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
HEATHER DANIELLE MAHASSEK DMD (OWNER)
(618) 709-2934
Entity
Organization
Contact information
Practice address
1170 BELT LINE RD, COLLINSVILLE, IL 62234-4372
(618) 345-1400
Mailing address
1170 BELT LINE RD, COLLINSVILLE, IL 62234-4372
(618) 345-1400
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1003291162
INDIVIDUAL NPI
IL
Enumeration date
05/03/2019
Last updated
05/03/2019
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