Alan Joseph Wickenhauser, D.M.D.
Individual provider Active NPI General Practice Dentistry · Bethalto, IL
NPI 1740468750 · NPPES record last updated Aug 9, 2017
Key facts
- NPI
- 1740468750
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 019-024793 (IL)
- Practice address
- 708 E Bethalto Blvd
Bethalto, IL 62010-1871 - Phone
- (618) 377-0044
- NPI assigned
- Feb 1, 2008
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 019-024793 | IL | MD | General Practice Dentistry |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 019-024793 | IL | Yes |
Addresses
Primary practice location
708 E Bethalto Blvd
Bethalto, IL 62010-1871
Mailing address
708 E Bethalto Blvd
Bethalto, IL 62010-1871
Phone (618) 377-0044
Other providers in Bethalto, IL
- Vernon Andersen Inc
- Billie Vincent
- Walgreen Co
- Ashley Dawn Weant
- Mallory Scrivner Welch
- Keith Michael Williams
- Robin R Wzorek
All providers in Bethalto, IL · General Practice Dentistry in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 9, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.