Organization
PREMIER DENTAL OF MT VERNON PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CARLA GEHA DMD (PRESIDENT/DENTIST)
(618) 315-6213
Entity
Organization
Contact information
Practice address
9 CUSUMANO PROFESSIONAL PLAZA DR, MOUNT VERNON, IL 62864-6736
(618) 315-6213
Mailing address
PO BOX 1003, MOUNT VERNON, IL 62864-0021
(618) 315-6213
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
019028108
IL
Other
Enumeration date
01/04/2012
Last updated
01/04/2012
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