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Organization
BI-STATE ORAL AND FACIAL SURGERY, LLC
Active
Organization
BI-STATE ORAL AND FACIAL SURGERY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BENJAMIN JACOB SCHLOTT MD, DMD (SINGLE MEMBER)
(618) 462-1646
Entity
Organization
Contact information
Practice address
3555 COLLEGE AVE, ALTON, IL 62002-5009
(618) 462-1646
(618) 462-5721
Mailing address
3555 COLLEGE AVE, ALTON, IL 62002-5009
(618) 462-1646
(618) 462-5721
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
021002736
IL
Other
Enumeration date
07/06/2016
Last updated
10/26/2022
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