| Mgm19 Inc | |
|
605 Courtyard Dr Saint Charles IL 60174-1463 | |
| (630) 377-7077 | |
| Not Available |
| Full Name | Mgm19 Inc |
|---|---|
| Speciality | Dentist - Oral And Maxillofacial Surgery |
| Location | 605 Courtyard Dr, Saint Charles, Illinois |
| Authorized Official Name and Position | Matthew Gregory Mcknight (OWNER/PRESIDENT) |
| Authorized Official Contact | 6303777077 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Mgm19 Inc 605 Courtyard Dr Saint Charles IL 60174-1463 Ph: (630) 377-7077 | Mgm19 Inc 605 Courtyard Dr Saint Charles IL 60174-1463 Ph: (630) 377-7077 |
| NPI Number | 1215579008 |
|---|---|
| Provider Enumeration Date | 10/13/2019 |
| Last Update Date | 03/12/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1215579008 | NPI | - | NPPES |
| 021.002827 | Other | IL | SPECIALIST LICENSE DENTISTRY |
| 036.144437 | Other | IL | MEDICAL LICENSE |
| 1518250125 | Other | IL | NPI |
| 019.029613 | Other | IL | DENTAL LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | (* (Not Available)) | Primary |
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