Organization
GREAT RIVERS DENTAL P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MATTHEW JAMES MCCULLOUGH DMD (PRESIDENT)
(618) 339-7248
Entity
Organization
Contact information
Practice address
708 E BETHALTO DR, BETHALTO, IL 62010-1871
(618) 377-0044
Mailing address
708 E BETHALTO DR, BETHALTO, IL 62010-1871
(618) 377-0044
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Enumeration date
01/17/2023
Last updated
01/17/2023
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