# GREAT RIVERS DENTAL P.C.

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

## Provider details

- **NPI number:** 1932814720
- **Authorized official:** DR. MATTHEW JAMES MCCULLOUGH DMD (PRESIDENT)
- **Authorized official phone:** (618) 339-7248

## Contact information

- **Practice address:** 708 E BETHALTO DR, BETHALTO, IL 62010-1871
- **Practice address phone:** (618) 377-0044
- **Mailing address:** 708 E BETHALTO DR, BETHALTO, IL 62010-1871
- **Mailing address phone:** (618) 377-0044

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261Q00000X | Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 01/17/2023
- **Last updated:** 01/17/2023