Organization
ASSOCIATED PEDIATRIC DENTISTRY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KEVIN C BEYERSDORFER (VICE PRESIDENT)
(618) 622-0212
Entity
Organization
Contact information
Practice address
4945 STONE FALLS CTR, SUITE B, O FALLON, IL 62269-7801
(618) 622-0212
Mailing address
4945 STONE FALLS CTR, SUITE B, O FALLON, IL 62269-7801
(618) 622-0212
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
—
—
Other
Enumeration date
12/22/2014
Last updated
12/22/2014
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