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General NPI Number Information
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NPI Number | 1164848644
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Entity Type | Organization
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Legal Business Name | RENEE E DOYLE, DMD, MS, P.C.
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Dates
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Enumeration Date | 03/08/2014
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Last Update Date | 03/08/2014
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Provider Practice Location Address
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Address Line | 107 N MAIN ST SUITE 2B
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City | COLUMBIA
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State | IL
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Zip | 62236-1757
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Country | US
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Telephone | 618-281-5896
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Fax |
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Provider Business Mailing Address
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Address Line | 107 N MAIN ST SUITE 2B
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City | COLUMBIA
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State | IL
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Zip | 62236-1757
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Country | US
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Telephone | 618-281-5896
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Fax |
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Authorized Official
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Title or Position | ORTHODONTIST
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Name | DR. RENEE ELIZABETH DOYLE
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Credential | DMD, MS
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Telephone | 618-281-5896
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 019028322
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License Number State | IL
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