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General NPI Number Information
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NPI Number | 1952497901
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Entity Type | Organization
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Legal Business Name | ASSOCIATED PEDIATRIC DENTISTRY LTD
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Dates
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Enumeration Date | 10/05/2006
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 4945 STONE FALLS CTR SUITE B
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City | O FALLON
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State | IL
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Zip | 62269-7802
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Country | US
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Telephone | 618-622-0212
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Fax | 618-622-1996
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Provider Business Mailing Address
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Address Line | 4945 STONE FALLS CTR SUITE B
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City | O FALLON
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State | IL
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Zip | 62269-7802
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Country | US
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Telephone | 618-622-0212
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Fax | 618-622-1996
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Authorized Official
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Title or Position | OWNER DENTIST
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Name | KEVIN CHARLES BEYERSDORFER
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Credential | DDS
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Telephone | 618-622-0212
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State | IL
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