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General NPI Number Information
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NPI Number | 1740812494
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Entity Type | Organization
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Legal Business Name | BANKHEAD ALTON ORTHODONTICS PC
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Dates
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Enumeration Date | 02/11/2020
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Last Update Date | 07/27/2020
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Provider Practice Location Address
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Address Line | 2828 HOMER ADAMS PKWY
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City | ALTON
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State | IL
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Zip | 62002-4855
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Country | US
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Telephone | 618-465-7423
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Fax |
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Provider Business Mailing Address
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Address Line | 3006 HIGHWAY K
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City | O FALLON
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State | MO
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Zip | 63368-8675
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Country | US
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Telephone | 636-734-7876
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Fax | 636-898-2001
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Authorized Official
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Title or Position | PRACTICE ADMINISTRATOR
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Name | MRS. ANDREA ROSE REITMEYER
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Credential |
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Telephone | 636-734-7876
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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 |
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License Number State |
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