Organization
FAUBLE DENTAL HEALTHCARE ASSOCIATES, PC
Active
Other names
Advanced Dental Care
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. DIANE V LANE (BUSINESS ASSISTANT)
(217) 228-1085
Entity
Organization
Contact information
Practice address
4561 MAINE ST, QUINCY, IL 62305-5851
(217) 228-1085
(217) 228-1089
Mailing address
4561 MAINE ST, QUINCY, IL 62305-5851
(217) 228-1085
(217) 228-1089
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
019-021341
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1004529
—
IL
Enumeration date
07/22/2006
Last updated
07/29/2008
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