Organization
DR.KENBROSHDDSPC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KEN NEAL BROSH DDS (PRES.)
(618) 566-7000
Entity
Organization
Contact information
Practice address
1180 N 6TH ST, MASCOUTAH, IL 62258-1178
(618) 566-7000
(618) 566-7000
Mailing address
1180 N 6TH ST, MASCOUTAH, IL 62258-1178
(618) 566-7000
(618) 566-7000
Taxonomy
Speciality
Code
Description
License number
State
305S00000X
Point of Service
Primary
019019341
IL
Other
Enumeration date
03/03/2008
Last updated
03/03/2008
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