Periodontics of Southern Illinois
NPI #1639224876 in Belleville, Illinois
Provider Information
- NPI Number
- 1639224876
- Entity Type
- Organization
- Organization Name
- Periodontics of Southern Illinois
- Primary Specialty
- Dentist - Periodontics
- Enumeration Date
- Jan 25, 2007
- Last Updated
- Aug 22, 2020
Practice Location
- Address
- #11 PARK PLACE
- City
- Belleville
- State
- Illinois
- ZIP Code
- 62226-2925
- Phone
- (618) 233-7300
Authorized Official
- Name
- DR. JOSEPJ A RENNER, D.D.S.
- Title
- OWNER
- Phone
- (618) 233-7300
Specialties & Taxonomy Codes
| Specialty |
|---|
| Dentist - Periodontics — Periodontics |
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