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Organization

HUMBERT ROAD DENTISTRY

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DAWN MICHELLE SHUDT (OFFICE MANAGER)
(618) 465-8100
Entity
Organization

Contact information

Practice address
4119 HUMBERT RD, ALTON, IL 62002-7116
(618) 465-8100
(618) 462-3530
Mailing address
4119 HUMBERT RD, ALTON, IL 62002-7116
(618) 465-8100
(618) 462-3530

Taxonomy

Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
019013894
IL
122300000X
Dentist
019028117
IL
122300000X
Dentist
19020630
IL

Other

Enumeration date
11/08/2010
Last updated
11/08/2010
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