Healthcare Provider Details

I. General information

NPI: 1265482046
Provider Name (Legal Business Name): TODAY'S DENTAL CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2006 MALL ST BLDG. 1
COLLINSVILLE IL
62234-1831
US

IV. Provider business mailing address

2006 MALL ST BLDG. 1
COLLINSVILLE IL
62234-1831
US

V. Phone/Fax

Practice location:
  • Phone: 618-345-8333
  • Fax: 618-345-9772
Mailing address:
  • Phone: 618-345-8333
  • Fax: 618-345-9772

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number StateIL

VIII. Authorized Official

Name: DR. RONALD W DILLOW
Title or Position: PRESIDENT
Credential: D.M.D.
Phone: 618-345-8333