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General NPI Number Information
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NPI Number | 1194381640
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Entity Type | Organization
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Legal Business Name | BILLY B. LAUN II, DDS, PC
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Dates
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Enumeration Date | 05/09/2019
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Last Update Date | 09/11/2019
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Provider Practice Location Address
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Address Line | 1111 E WALNUT ST STE B
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City | CARBONDALE
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State | IL
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Zip | 62901-5000
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Country | US
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Telephone | 618-529-2571
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Fax | 618-529-2572
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Provider Business Mailing Address
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Address Line | 1111 E WALNUT ST STE B
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City | CARBONDALE
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State | IL
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Zip | 62901-5000
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | BILLY B LAUN II
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Credential | DDS
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Telephone | 618-529-2571
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number |
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License Number State |
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