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General NPI Number Information
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NPI Number | 1790122620
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Entity Type | Individual
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Provider Name | ANN MARIE REDMOND D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 06/01/2013
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Last Update Date | 07/13/2015
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Provider Practice Location Address
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Address Line | 1501 N STATE ROUTE 50
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City | BOURBONNAIS
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State | IL
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Zip | 60914-4429
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Country | US
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Telephone | 217-408-2511
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Fax |
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Provider Business Mailing Address
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Address Line | 1902 N PROSPECT AVE
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City | CHAMPAIGN
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State | IL
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Zip | 61822-1411
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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 |
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 019029387
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 12012246A
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License Number State | IN
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