Organization
ST. LOUIS SURGICAL ASSOCIATES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID GUILBEAULT DMD (OWNER)
(618) 643-9523
Entity
Organization
Contact information
Practice address
24 GINGER CREEK PKWY, GLEN CARBON, IL 62034-3502
(618) 655-1580
Mailing address
24 GINGER CREEK PKWY, GLEN CARBON, IL 62034-3502
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
19025397
IL
Other
Enumeration date
09/06/2012
Last updated
11/30/2015
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