Individual
JEFFREY C WHITESIDE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
2943 W WHITE OAKS DR, SPRINGFIELD, IL 62704-6544
(217) 793-8899
Mailing address
2943 W WHITE OAKS DR, SPRINGFIELD, IL 62704-6544
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
019028074
IL
Other
Enumeration date
07/17/2009
Last updated
07/17/2009
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