Provider Demographics
NPI:1043480098
Name:DUQUOIN DENTAL ASSOCIATES, LTD.
Entity Type:Organization
Organization Name:DUQUOIN DENTAL ASSOCIATES, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ISAAC
Authorized Official - Middle Name:E
Authorized Official - Last Name:DAVISON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:618-542-5889
Mailing Address - Street 1:1226 S WASHINGTON ST
Mailing Address - Street 2:PO BOX 330
Mailing Address - City:DU QUOIN
Mailing Address - State:IL
Mailing Address - Zip Code:62832-3853
Mailing Address - Country:US
Mailing Address - Phone:618-542-8832
Mailing Address - Fax:618-542-9255
Practice Address - Street 1:1226 S WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:DU QUOIN
Practice Address - State:IL
Practice Address - Zip Code:62832-3853
Practice Address - Country:US
Practice Address - Phone:618-542-8832
Practice Address - Fax:618-542-9255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-05
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental