Individual
DR. SCOTT MICHAEL BIETSCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
402 S LEWIS LN, CARBONDALE, IL 62901-3547
(618) 519-9200
Mailing address
PO BOX 577, 109 CALIFORNIA ST, CARTERVILLE, IL 62818-0577
(618) 985-8221
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
019.028399
IL
1223P0221X
Pediatric Dentistry
021002781
IL
Other
Enumeration date
07/20/2010
Last updated
12/09/2016
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