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General NPI Number Information
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NPI Number | 1720129356
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Entity Type | Organization
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Legal Business Name | MACON COUNTY HEALTH DEPARTMENT
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Dates
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Enumeration Date | 02/08/2007
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Last Update Date | 06/25/2008
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Provider Practice Location Address
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Address Line | 1221 E CONDIT ST
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City | DECATUR
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State | IL
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Zip | 62521-1405
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Country | US
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Telephone | 217-423-9930
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Fax | 217-423-7436
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Provider Business Mailing Address
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Address Line | 1221 E CONDIT ST
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City | DECATUR
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State | IL
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Zip | 62521-1405
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Country | US
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Telephone | 217-423-9930
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Fax | 217-423-7436
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Authorized Official
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Title or Position | DENTAL CLINIC DIRECTOR
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Name | DR. KENNETH PRESTON WEBB
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Credential | D.M.D.
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Telephone | 217-423-9930
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251K00000X
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Taxonomy Name | Public Health or Welfare Agency
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License Number | 0190101808
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License Number State | IL
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