Provider Demographics
NPI:1932375359
Name:GALLATIN COUNTY DENTAL CLINIC
Entity Type:Organization
Organization Name:GALLATIN COUNTY DENTAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:STACIA
Authorized Official - Middle Name:IRENE
Authorized Official - Last Name:MCGUIRE
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:618-727-4300
Mailing Address - Street 1:5135 HIGHWAY 13
Mailing Address - Street 2:
Mailing Address - City:JUNCTION
Mailing Address - State:IL
Mailing Address - Zip Code:62954
Mailing Address - Country:US
Mailing Address - Phone:618-272-7630
Mailing Address - Fax:618-272-7625
Practice Address - Street 1:5135 HIGHWAY 13
Practice Address - Street 2:
Practice Address - City:JUNCTION
Practice Address - State:IL
Practice Address - Zip Code:62954
Practice Address - Country:US
Practice Address - Phone:618-272-7630
Practice Address - Fax:618-272-7625
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-06
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty