Organization
ORTHODONTIC ASSOCIATES OF COLUMBIA AND WATERLOO
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRENT DEE BANKHEAD DDS, MS (DR.)
(618) 281-3399
Entity
Organization
Contact information
Practice address
1060 ADMIRAL WEINEL BLVD, COLUMBIA, IL 62236-1988
(618) 281-3399
Mailing address
1060 ADMIRAL WEINEL BLVD, COLUMBIA, IL 62236-1988
(618) 281-3399
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
019025290
IL
Other
Enumeration date
04/02/2014
Last updated
04/02/2014
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