Provider Demographics
NPI:1336352608
Name:AFFORDABLE DENTISTRY TODAY, PC
Entity type:Organization
Organization Name:AFFORDABLE DENTISTRY TODAY, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:INS COOD
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:KROEGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-540-5100
Mailing Address - Street 1:5300 WEST MAIN
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62226
Mailing Address - Country:US
Mailing Address - Phone:618-234-2908
Mailing Address - Fax:618-234-3278
Practice Address - Street 1:5300 WEST MAIN
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62226
Practice Address - Country:US
Practice Address - Phone:618-234-2908
Practice Address - Fax:618-234-3278
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AFFORDABLE DENTISTRY TODAY, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-07
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty