Provider Demographics
NPI:1447400874
Name:DAN K. SPECKHART D.M.D. AND DOUGLAS J. WHITE D.M.D., P.C.
Entity Type:Organization
Organization Name:DAN K. SPECKHART D.M.D. AND DOUGLAS J. WHITE D.M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAN
Authorized Official - Middle Name:K
Authorized Official - Last Name:SPECKHART
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:217-285-5553
Mailing Address - Street 1:PO BOX 288
Mailing Address - Street 2:
Mailing Address - City:PITTSFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62363-0288
Mailing Address - Country:US
Mailing Address - Phone:217-285-5553
Mailing Address - Fax:
Practice Address - Street 1:110 E FAYETTE ST
Practice Address - Street 2:
Practice Address - City:PITTSFIELD
Practice Address - State:IL
Practice Address - Zip Code:62363-1949
Practice Address - Country:US
Practice Address - Phone:217-285-5553
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-23
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL060.0024751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty