Provider Demographics
NPI:1194381640
Name:BILLY B. LAUN II, DDS, PC
Entity Type:Organization
Organization Name:BILLY B. LAUN II, DDS, PC
Other - Org Name:ORAL & MAXILLOFACIAL SURGERY OF CARBONDALE, INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:BILLY
Authorized Official - Middle Name:B
Authorized Official - Last Name:LAUN
Authorized Official - Suffix:II
Authorized Official - Credentials:DDS
Authorized Official - Phone:618-529-2571
Mailing Address - Street 1:1111 E WALNUT ST STE B
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:IL
Mailing Address - Zip Code:62901-5000
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1111 E WALNUT ST STE B
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:IL
Practice Address - Zip Code:62901-5000
Practice Address - Country:US
Practice Address - Phone:618-529-2571
Practice Address - Fax:618-529-2572
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-09
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty