Provider Demographics
NPI:1164848644
Name:RENEE E DOYLE, DMD, MS, P.C.
Entity Type:Organization
Organization Name:RENEE E DOYLE, DMD, MS, P.C.
Other - Org Name:DOYLE ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:DOYLE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MS
Authorized Official - Phone:618-281-5896
Mailing Address - Street 1:107 N MAIN ST
Mailing Address - Street 2:SUITE 2B
Mailing Address - City:COLUMBIA
Mailing Address - State:IL
Mailing Address - Zip Code:62236-1757
Mailing Address - Country:US
Mailing Address - Phone:618-281-5896
Mailing Address - Fax:
Practice Address - Street 1:107 N MAIN ST
Practice Address - Street 2:SUITE 2B
Practice Address - City:COLUMBIA
Practice Address - State:IL
Practice Address - Zip Code:62236-1757
Practice Address - Country:US
Practice Address - Phone:618-281-5896
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-08
Last Update Date:2014-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190283221223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty