Individual
DR. ELIANE FOSSATTI GONCALVES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
802 N 9TH ST, SPRINGFIELD, IL 62702-6309
(217) 679-2896
Mailing address
802 N 9TH ST, SPRINGFIELD, IL 62702-6309
(217) 679-2896
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
019032815
IL
1223G0001X
General Practice Dentistry
2021020128
MO
Other
Enumeration date
07/20/2020
Last updated
06/23/2021
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