Provider Demographics
NPI:1457474637
Name:ROBERT J MCDILL D M D LTD
Entity Type:Organization
Organization Name:ROBERT J MCDILL D M D LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:MCDILL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:618-398-5770
Mailing Address - Street 1:9 CANTY LN
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:62208-2623
Mailing Address - Country:US
Mailing Address - Phone:618-398-5770
Mailing Address - Fax:
Practice Address - Street 1:9 CANTY LN
Practice Address - Street 2:
Practice Address - City:FAIRVIEW HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:62208-2623
Practice Address - Country:US
Practice Address - Phone:618-398-5770
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL19A14624261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
=========OtherFED ID