MEDICARE: CARLEIGH PRANE DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry		IL

General Provider Information

NPI Number	:	1689633810
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARLEIGH PRANE DMD

Provider Business Mailing Address
First Line	:	4945 STONE FALLS CTR
Second Line	:	SUITE A
City	:	O FALLON
State	:	IL
Zip	:	62269-7802
Country	:	US
Telephone Number	:	618-624-2800
Fax Number	:

Provider Business Practice Location Address
First Line	:	4945 STONE FALLS CTR
Second Line	:	SUITE A
City	:	O FALLON
State	:	IL
Zip	:	62269-7802
Country	:	US
Telephone Number	:	618-624-2800
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/17/2006
Last Update Date	:	07/08/2007

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Directions to “ CARLEIGH PRANE DMD” Practice Location

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