Individual
JENNIFER E MIHALOPULOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
103 N. APPLEKNOCKER, COBDEN, IL 62920-2117
(618) 893-4005
(618) 893-1476
Mailing address
513 N MAIN ST, ANNA, IL 62906-1668
(618) 833-4471
(618) 833-8878
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
019-026916
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
019-026916
—
IL
Enumeration date
12/22/2005
Last updated
05/19/2008
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