| Southern Illinois Oral & Maxillofacial Surgery, Ltd. | |
|
2900 Frank Scott Pkwy W Suite 960 Belleville IL 62223-5000 | |
| (618) 233-8080 | |
| (618) 233-1192 |
| Full Name | Southern Illinois Oral & Maxillofacial Surgery, Ltd. |
|---|---|
| Speciality | Dentist - Oral And Maxillofacial Surgery |
| Location | 2900 Frank Scott Pkwy W, Belleville, Illinois |
| Authorized Official Name and Position | Michael R. Hesterberg (PRESIDENT) |
| Authorized Official Contact | 6182338080 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Southern Illinois Oral & Maxillofacial Surgery, Ltd. 2900 Frank Scott Pkwy W Suite 960 Belleville IL 62223-5000 Ph: (618) 233-8080 | Southern Illinois Oral & Maxillofacial Surgery, Ltd. 2900 Frank Scott Pkwy W Suite 960 Belleville IL 62223-5000 Ph: (618) 233-8080 |
| NPI Number | 1538180617 |
|---|---|
| Provider Enumeration Date | 07/22/2006 |
| Last Update Date | 11/24/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1538180617 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | 021-001364 (Illinois) | Primary |
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