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General NPI Number Information
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NPI Number | 1104939735
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Entity Type | Organization
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Legal Business Name | PINCKNEYVILLE DENTAL CARE
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Dates
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Enumeration Date | 08/17/2006
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Last Update Date | 07/30/2014
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Provider Practice Location Address
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Address Line | 1000 S MAIN ST
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City | PINCKNEYVILLE
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State | IL
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Zip | 62274-1772
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Country | US
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Telephone | 618-357-2445
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Fax | 618-357-9549
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Provider Business Mailing Address
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Address Line | PO BOX 469
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City | PINCKNEYVILLE
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State | IL
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Zip | 62274-0469
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Country | US
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Telephone | 618-357-2445
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Fax | 618-357-9549
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Authorized Official
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Title or Position | OWNER
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Name | DR. RALPH KANE CHAPMAN
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Credential | DMD
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Telephone | 618-357-2445
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 19020196
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License Number State | IL
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