Individual
ETHAN THOMAS GROUNDS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
300 SMALL ST STE D, HARRISBURG, IL 62946-3325
(618) 252-1725
Mailing address
300 SMALL ST STE D, HARRISBURG, IL 62946-3325
(618) 252-1725
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
019.031182
IL
Other
Enumeration date
06/19/2017
Last updated
01/02/2024
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