Fairview Heights Dentistry, Pllc
NPI #1811558208 in Fairview Heights, Illinois
Provider Information
- NPI Number
- 1811558208
- Entity Type
- Organization
- Organization Name
- Fairview Heights Dentistry, Pllc
- Primary Specialty
- Dentist
- Enumeration Date
- Jun 26, 2019
- Last Updated
- Mar 8, 2022
Practice Location
- Address
- 6407 N ILLINOIS ST
- City
- Fairview Heights
- State
- Illinois
- ZIP Code
- 62208-2720
- Phone
- (618) 310-0263
Authorized Official
- Name
- BRYAN K WATANABE
- Title
- OWNER
- Phone
- (618) 310-0263
Specialties & Taxonomy Codes
| Specialty |
|---|
| Dentist |
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