Healthcare Provider Details

I. General information

NPI: 1689590697
Provider Name (Legal Business Name): ALYSSA MCLAUGHLIN
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 COLLEGE AVE
ALTON IL
62002-4742
US

IV. Provider business mailing address

2800 COLLEGE AVE
ALTON IL
62002-4742
US

V. Phone/Fax

Practice location:
  • Phone: 618-474-7000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number019.037201
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: