Organization
STOP ELEVEN DENTAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID GUILBEAULT DDS (DENTIST/OWNER)
(618) 248-2038
Entity
Organization
Contact information
Practice address
4950 E STOP 11 RD, STE A, INDIANAPOLIS, IN 46237-9100
(618) 248-2038
Mailing address
1922 EDWARDSVILLE CLUB PLAZA CT, EDWARDSVILLE, IL 62025-3717
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
12012272A
IN
Other
Enumeration date
04/30/2015
Last updated
03/11/2016
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