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General NPI Number Information
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NPI Number | 1952154288
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Entity Type | Organization
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Legal Business Name | CARROLLTON FAMILY DENTAL
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Dates
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Enumeration Date | 04/08/2024
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Last Update Date | 04/08/2024
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Provider Practice Location Address
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Address Line | 603 5TH ST
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City | CARROLLTON
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State | IL
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Zip | 62016-1401
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Country | US
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Telephone | 217-942-5033
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Fax | 217-942-9503
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Provider Business Mailing Address
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Address Line | 603 5TH ST
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City | CARROLLTON
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State | IL
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Zip | 62016-1401
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Country | US
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Telephone | 217-942-5033
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Fax | 217-942-9503
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. STACY SUE COX
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Credential |
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Telephone | 618-520-0127
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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