Provider Demographics
NPI:1821462052
Name:WOHLFORD-SCHUETTE DENTAL, LLC
Entity Type:Organization
Organization Name:WOHLFORD-SCHUETTE DENTAL, LLC
Other - Org Name:SOUTHERN ILLINOIS PEDIATRIC DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:WOHLFORD
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MS
Authorized Official - Phone:618-791-2794
Mailing Address - Street 1:1320 COLUMBIA CTR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:IL
Mailing Address - Zip Code:62236-2561
Mailing Address - Country:US
Mailing Address - Phone:618-719-2400
Mailing Address - Fax:
Practice Address - Street 1:1320 COLUMBIA CTR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:IL
Practice Address - Zip Code:62236-2561
Practice Address - Country:US
Practice Address - Phone:618-719-2400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-27
Last Update Date:2015-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190283141223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty