ETHAN DUEWER

SPRINGFIELD, IL
NPI1972023117
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy122300000X Dentist
(Licence: IL  019.031206)
Additional Taxonomies1223G0001X Dentist, General Practice
(Licence: IL  019.031206)
Enumeration Date2017-06-20
Last Update Date2022-01-18
Business Address
ETHAN DUEWER DMD
1140 RICKARD RD STE 1
SPRINGFIELD, IL 62704-6385
Phone number: 217-787-3096
Mailing Address
ETHAN DUEWER DMD
1140 RICKARD RD STE 1
SPRINGFIELD, IL 62704-6385
Phone number: