Provider Demographics
NPI:1437329968
Name:BLUESPRINGS FAMILY DENTISTRY
Entity Type:Organization
Organization Name:BLUESPRINGS FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-667-6650
Mailing Address - Street 1:7656 PLUMMER BUSINESS DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:IL
Mailing Address - Zip Code:62294-7604
Mailing Address - Country:US
Mailing Address - Phone:618-667-6650
Mailing Address - Fax:618-667-6615
Practice Address - Street 1:7656 PLUMMER BUSINESS DR
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:IL
Practice Address - Zip Code:62294-7604
Practice Address - Country:US
Practice Address - Phone:618-667-6650
Practice Address - Fax:618-667-6615
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-12
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty