Individual
MRS. MARY ANN SOUTHERLAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RDH, PHDH
Contact information
Practice address
109 3RD ST, LINCOLN, IL 62656-2604
(217) 735-2317
Mailing address
109 3RD ST, LINCOLN, IL 62656-2604
(217) 735-2317
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
020-004826
IL
Other
Enumeration date
11/19/2020
Last updated
11/19/2020
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