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Organization

2102 RANDOLPH VANDALIA PROFESSIONAL, LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
PAM DRAPER (VP OF OPERATIONS)
(602) 391-4086
Entity
Organization

Contact information

Practice address
2102 W RANDOLPH ST, VANDALIA, IL 62471-1973
(618) 283-4900
Mailing address
2102 W RANDOLPH ST, VANDALIA, IL 62471-1973
(618) 283-4900

Taxonomy

Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary

Other

Enumeration date
10/29/2025
Last updated
10/29/2025
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