Organization
SHAMROCK DENTAL GROUP, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROBERT HABERKORN D.D.S , M.B.A (DENTIST)
(573) 334-6009
Entity
Organization
Contact information
Practice address
2502 WILLIAM ST, SUITE 2A, CAPE GIRARDEAU, MO 63703-5763
(573) 334-6009
(573) 334-7675
Mailing address
2502 WILLIAM ST, SUITE 2A, CAPE GIRARDEAU, MO 63703-5763
(573) 334-6009
(573) 334-7675
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2002031756
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1005255/106930
—
IL
Enumeration date
04/17/2008
Last updated
04/17/2008
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