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General NPI Number Information
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NPI Number | 1629293709
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Entity Type | Individual
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Provider Name | KENDALL MARIE WACHTER DMD
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Gender | Female
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Dates
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Enumeration Date | 04/16/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 374 E GRAND AVE STUDENT HEALTH CENTER SIUC
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City | CARBONDALE
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State | IL
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Zip | 62901
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Country | US
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Telephone | 618-536-2421
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Fax | 618-453-3477
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Provider Business Mailing Address
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Address Line | 520 CANARY LANE
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City | CARTERVILLE
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State | IL
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Zip | 62918
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Country | US
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Telephone | 618-985-6997
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 |
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License Number State | IL
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