Organization
ORTHODONTIC ASSOCIATES OF COLUMBIA AND WATERLOO
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRENT DEE BANKHEAD DDS, MS (DR.)
(618) 281-7979
Entity
Organization
Contact information
Practice address
224 BRADFORD LANE SUITE B, WATERLOO, IL 62298
(618) 939-7070
Mailing address
224 BRADFORD LN STE B, WATERLOO, IL 62298-3369
(618) 281-7979
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
019025290
IL
Other
Enumeration date
04/03/2014
Last updated
04/03/2014
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