Provider Demographics
NPI:1720129356
Name:MACON COUNTY HEALTH DEPARTMENT
Entity Type:Organization
Organization Name:MACON COUNTY HEALTH DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTAL CLINIC DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:PRESTON
Authorized Official - Last Name:WEBB
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:217-423-9930
Mailing Address - Street 1:1221 E CONDIT ST
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62521-1405
Mailing Address - Country:US
Mailing Address - Phone:217-423-9930
Mailing Address - Fax:217-423-7436
Practice Address - Street 1:1221 E CONDIT ST
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62521-1405
Practice Address - Country:US
Practice Address - Phone:217-423-9930
Practice Address - Fax:217-423-7436
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190101808251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare