Provider Demographics
NPI:1689218430
Name:THE CENTER FOR COMPLETE HEALTH DENTISTRY
Entity Type:Organization
Organization Name:THE CENTER FOR COMPLETE HEALTH DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:FOLEY
Authorized Official - Middle Name:M
Authorized Official - Last Name:ANDREA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:618-288-9670
Mailing Address - Street 1:590 GLEN CROSSING RD
Mailing Address - Street 2:
Mailing Address - City:GLEN CARBON
Mailing Address - State:IL
Mailing Address - Zip Code:62034-1519
Mailing Address - Country:US
Mailing Address - Phone:618-288-8828
Mailing Address - Fax:
Practice Address - Street 1:590 GLEN CROSSING RD
Practice Address - Street 2:
Practice Address - City:GLEN CARBON
Practice Address - State:IL
Practice Address - Zip Code:62034-1519
Practice Address - Country:US
Practice Address - Phone:618-288-8828
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-05
Last Update Date:2019-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty