Organization
INNOVATION DENTAL AND IMPLANT LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DIANA LIFRITZ (DIRECTOR OF HUMAN RESOURCES)
(618) 873-7500
Entity
Organization
Contact information
Practice address
717 INSIGHT AVE, O FALLON, IL 62269-2151
(618) 277-6550
Mailing address
1922 EDWARDSVILLE CLUB PLAZA CT, EDWARDSVILLE, IL 62025-3717
(618) 277-6550
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
Other
Enumeration date
07/20/2026
Last updated
07/20/2026
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