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General NPI Number Information
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NPI Number | 1447400874
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Entity Type | Organization
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Legal Business Name | DAN K. SPECKHART D.M.D. AND DOUGLAS J. WHITE D.M.D., P.C.
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Dates
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Enumeration Date | 09/23/2008
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Last Update Date | 09/23/2008
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Provider Practice Location Address
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Address Line | 110 E FAYETTE ST
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City | PITTSFIELD
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State | IL
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Zip | 62363-1949
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Country | US
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Telephone | 217-285-5553
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 288
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City | PITTSFIELD
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State | IL
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Zip | 62363-0288
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Country | US
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Telephone | 217-285-5553
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DAN K. SPECKHART
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Credential | D.M.D.
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Telephone | 217-285-5553
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 060.002475
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License Number State | IL
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