Associated Pediatric Dentistry, LLC

Organization Active NPI Pediatric Dentistry · O Fallon, IL

NPI 1235527490 · NPPES record last updated Dec 22, 2014

Key facts

NPI
1235527490
Entity type
Organization (NPI type 2)
Primary specialty
Pediatric Dentistry 1223P0221X
Legal business name
ASSOCIATED PEDIATRIC DENTISTRY, LLC
Practice address
4945 Stone Falls Ctr
Suite B
O Fallon, IL 62269-7801
Phone
(618) 622-0212
NPI assigned
Dec 22, 2014
Organization subpart
No

Authorized official

Name
Dr. Kevin C Beyersdorfer
Title
Vice President
Phone
(618) 622-0212

National Provider Directory

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Dentistry
Group: 193400000X SINGLE SPECIALTY GROUP
1223P0221X Yes

Addresses

Primary practice location

4945 Stone Falls Ctr
Suite B
O Fallon, IL 62269-7801

Mailing address

4945 Stone Falls Ctr
Suite B
O Fallon, IL 62269-7801
Phone (618) 622-0212

Other providers in O Fallon, IL

All providers in O Fallon, IL · Pediatric Dentistry in Illinois

Sources for this page

Verify at the official NPI Registry.