Provider Demographics
NPI:1376850784
Name:TEEL FAMILY DENTISTRY, LLC
Entity Type:Organization
Organization Name:TEEL FAMILY DENTISTRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:A
Authorized Official - Last Name:TEEL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:618-542-3166
Mailing Address - Street 1:215 S WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:DU QUOIN
Mailing Address - State:IL
Mailing Address - Zip Code:62832-1804
Mailing Address - Country:US
Mailing Address - Phone:618-542-3166
Mailing Address - Fax:618-542-3167
Practice Address - Street 1:215 S WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:DU QUOIN
Practice Address - State:IL
Practice Address - Zip Code:62832-1804
Practice Address - Country:US
Practice Address - Phone:618-542-3166
Practice Address - Fax:618-542-3167
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-07
Last Update Date:2010-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019027488261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental