Individual
KYLE R CHILDERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD, MS
Contact information
Practice address
201 W WASHINGTON ST, BENTON, IL 62812-1382
(618) 438-2815
(618) 439-6127
Mailing address
201 W WASHINGTON ST, BENTON, IL 62812-1382
(618) 438-2815
(618) 439-6127
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
019022000
IL
Other
Enumeration date
02/13/2009
Last updated
02/13/2009
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