| Bi-state Oral And Facial Surgery, Llc | |
|
3555 College Ave Alton IL 62002-5009 | |
| (618) 462-1646 | |
| (618) 462-5721 |
| Full Name | Bi-state Oral And Facial Surgery, Llc |
|---|---|
| Speciality | Dentist |
| Location | 3555 College Ave, Alton, Illinois |
| Authorized Official Name and Position | Benjamin Jacob Schlott (SINGLE MEMBER) |
| Authorized Official Contact | 6184621646 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Bi-state Oral And Facial Surgery, Llc 3555 College Ave Alton IL 62002-5009 Ph: (618) 462-1646 | Bi-state Oral And Facial Surgery, Llc 3555 College Ave Alton IL 62002-5009 Ph: (618) 462-1646 |
| NPI Number | 1669824439 |
|---|---|
| Provider Enumeration Date | 07/06/2016 |
| Last Update Date | 10/26/2022 |
| Medicare PECOS PAC ID | 4587952189 |
|---|---|
| Medicare Enrollment ID | O20161014000670 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1669824439 | NPI | - | NPPES |
| 1891938296 | Medicaid | MO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | 021002736 (Illinois) | Primary |
| Provider Name | Benjamin J Schlott |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1891938296 PECOS PAC ID: 3274702329 Enrollment ID: I20161014000819 |
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