Orthodontic Associates of Columbia and Waterloo

NPI #1952729279 in Waterloo, Illinois

Provider Information

NPI Number: 1952729279
Entity Type: Organization
Organization Name: Orthodontic Associates of Columbia and Waterloo
Primary Specialty: Dentist - Orthodontics and Dentofacial Orthopedics
Enumeration Date: Apr 3, 2014
Last Updated: Apr 3, 2014

Practice Location

Address: 224 BRADFORD LANE SUITE B
City: Waterloo
State: Illinois
ZIP Code: 62298
Phone: (618) 939-7070

Authorized Official

Name: DR. BRENT DEE BANKHEAD, DDS, MS
Title: DR.
Phone: (618) 281-7979

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist - Orthodontics and Dentofacial Orthopedics — Orthodontics and Dentofacial Orthopedics	1223X0400X	Primary

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