# BI-STATE ORAL AND FACIAL SURGERY, LLC

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

## Provider details

- **NPI number:** 1669824439
- **Authorized official:** DR. BENJAMIN JACOB SCHLOTT MD, DMD (SINGLE MEMBER)
- **Authorized official phone:** (618) 462-1646

## Contact information

- **Practice address:** 3555 COLLEGE AVE, ALTON, IL 62002-5009
- **Practice address phone:** (618) 462-1646
- **Practice address fax:** (618) 462-5721
- **Mailing address:** 3555 COLLEGE AVE, ALTON, IL 62002-5009
- **Mailing address phone:** (618) 462-1646
- **Mailing address fax:** (618) 462-5721

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 021002736 | IL | Yes |

## Other

- **Enumeration date:** 07/06/2016
- **Last updated:** 10/26/2022