Organization
SOUTHERN ILLINOIS ORAL & MAXILLOFACIAL SURGERY, LTD.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL R. HESTERBERG D.M.D. (PRESIDENT)
(618) 233-8080
Entity
Organization
Contact information
Practice address
2900 FRANK SCOTT PKWY W, SUITE 960, BELLEVILLE, IL 62223-5000
(618) 233-8080
(618) 233-1192
Mailing address
2900 FRANK SCOTT PKWY W, SUITE 960, BELLEVILLE, IL 62223-5000
(618) 233-8080
(618) 233-1192
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
021-001364
IL
Other
Enumeration date
07/22/2006
Last updated
11/24/2014
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