Provider Demographics
NPI:1780316596
Name:DEER RUN DENTAL, PC
Entity type:Organization
Organization Name:DEER RUN DENTAL, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:J
Authorized Official - Last Name:SCHILLINGER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:618-698-1871
Mailing Address - Street 1:717 INSIGHT AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:O'FALLON
Mailing Address - State:IL
Mailing Address - Zip Code:62269
Mailing Address - Country:US
Mailing Address - Phone:618-277-6550
Mailing Address - Fax:618-800-2906
Practice Address - Street 1:717 INSIGHT AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:O'FALLON
Practice Address - State:IL
Practice Address - Zip Code:62269
Practice Address - Country:US
Practice Address - Phone:618-277-6550
Practice Address - Fax:618-800-2906
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-29
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty