Individual
DR. MICHAEL R HESTERBERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
2900 FRANK SCOTT PKWY W, SUITE 960, BELLEVILLE, IL 62223-5000
(618) 233-8080
(618) 233-1192
Mailing address
2900 FRANK SCOTT PKWY W, SUITE 960, BELLEVILLE, IL 62223-5000
(618) 233-8080
(618) 233-1192
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
—
IL
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
133110
HEALTHLINK PROVIDER #
IL
01
—
28109
BLUE SHIELD IL PROVIDER #
IL
01
—
567048
UNITED CONCORIDA PROVIDER
IL
Enumeration date
10/04/2005
Last updated
07/17/2007
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