Individual
DR. JOHN SPENCER PHELPS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
180 STONE LAKE DR, MAKANDA, IL 62958-2730
(618) 549-4550
Mailing address
180 STONE LAKE DRIVE, MAKANDA, IL 62958-2730
(618) 549-4550
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
019014490
IL
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
021000826
IL
Other
Enumeration date
09/17/2012
Last updated
09/17/2012
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