Organization
LINCOLN PLACE DENTAL PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GERALD WAYNE DORTCH DMD (OWNER)
(618) 257-9189
Entity
Organization
Contact information
Practice address
114 LINCOLN PLACE CT, BELLEVILLE, IL 62221-5884
(618) 257-9189
(618) 257-9253
Mailing address
114 LINCOLN PLACE CT, BELLEVILLE, IL 62221-5884
(618) 257-9189
(618) 257-9253
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
019016287
IL
Other
Enumeration date
03/07/2012
Last updated
03/07/2012
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