Individual
MRS. REBECCA LEE COALSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
2 TERMINAL DR, SUITE 8, EAST ALTON, IL 62024-2268
(618) 259-1419
(618) 259-1502
Mailing address
2 TERMINAL DR, SUITE 8, EAST ALTON, IL 62024-2268
(618) 259-1419
(618) 259-1502
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
019026829
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
019026829
—
IL
Enumeration date
10/04/2006
Last updated
11/21/2011
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