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General NPI Number Information
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NPI Number | 1932029907
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Entity Type | Organization
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Legal Business Name | INNOVATION DENTAL AND IMPLANT LLC
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Dates
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Enumeration Date | 07/20/2026
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Last Update Date | 07/20/2026
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Provider Practice Location Address
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Address Line | 717 INSIGHT AVE
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City | O FALLON
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State | IL
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Zip | 62269-2151
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Country | US
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Telephone | 618-277-6550
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Fax |
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Provider Business Mailing Address
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Address Line | 1922 EDWARDSVILLE CLUB PLAZA CT
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City | EDWARDSVILLE
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State | IL
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Zip | 62025-3717
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Country | US
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Telephone | 618-277-6550
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF HUMAN RESOURCES
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Name | DIANA LIFRITZ
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Credential |
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Telephone | 618-873-7500
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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 |
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License Number State |
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