Organization Name: | DUQUOIN DENTAL ASSOCIATES, LTD. |
NPI Number: | 1043480098 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | ISAAC E DAVISON (PRESIDENT/OWNER) |
Mailing Address: | 1226 S Washington St Du Quoin |
State: | IL US |
Postal Code: | 628323853 |
Phone Number: | 6185428832 |
Fax Number: | 6185429255 |
NPI Enumeration Date: | 03/05/2008 |
NPI Last Update Date: | 03/05/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QD0000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Dental |
Taxonomy Definition: |