Healthcare Provider Details

I. General information

NPI: 1063076016
Provider Name (Legal Business Name): LAURA SCHALL DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2019
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 E WASHINGTON ST
MONTICELLO IL
61856-1641
US

IV. Provider business mailing address

112 E WASHINGTON ST
MONTICELLO IL
61856-1641
US

V. Phone/Fax

Practice location:
  • Phone: 217-762-4366
  • Fax: 217-762-5143
Mailing address:
  • Phone: 217-762-4366
  • Fax: 217-762-5143

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number019.031730
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: