Organization
MARYVILLE FAMILY DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. AMANDA HENDERSON (ACCOUNTS PAYABLE)
(618) 288-6201
Entity
Organization
Contact information
Practice address
2921 NORTH CENTER STREET, SUITE 8-9, MARYVILLE, IL 62062
(618) 288-7804
(618) 288-7918
Mailing address
26 GINGER CREEK PKWY, PO BOX 430, GLEN CARBON, IL 62034-3502
(618) 288-6201
(618) 288-6452
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
IL
Other
Enumeration date
10/23/2009
Last updated
10/08/2012
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