Great Rivers Dental P.c.

NPI #1932814720 in Bethalto, Illinois

Provider Information

NPI Number: 1932814720
Entity Type: Organization
Organization Name: Great Rivers Dental P.c.
Primary Specialty: Clinic/Center
Enumeration Date: Jan 17, 2023
Last Updated: Jan 17, 2023

Practice Location

Address: 708 E BETHALTO DR
City: Bethalto
State: Illinois
ZIP Code: 62010-1871
Phone: (618) 377-0044

Authorized Official

Name: DR. MATTHEW JAMES MCCULLOUGH, DMD
Title: PRESIDENT
Phone: (618) 339-7248

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Clinic/Center	261Q00000X	Primary

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