Jon Karl Dively DDS

NPI 1659596393 - Dentist - 1223G0001X

NPI Details
NPI 1659596393
Gender Male
Enumeration Date 04/16/2007
Last Updated 07/08/2007
Entity Type Individual
Active Over 9 years ago
Practice Location
4 DOCTORS LN
MACOMB IL, 61455-3376, US
Phone (309) 837-3918
Fax
Business Location
4 DOCTORS LN
MACOMB IL, 61455-3376, US
Phone (309) 837-3918
Fax
Toxanomy
Taxonomy Code 1223G0001X
License State Illinois
License Number 19A13962
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According to our database, Dr. Jon Karl Dively DDS NPI is 1659596393, taxonomy code is 1223G0001X and license number is 19A13962, license state is located at Illinois. Jon Karl Dively DDS physically located at 4 Doctors Ln, Macomb IL, 61455-3376. NPI Number Jon Karl Dively DDS has the Individual type.

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1659596393 NPI number is provided on an as is basis without warranty of any kind. 1659596393 is maintained by the National Plan & Provider Enumeration System. The contents of Jon Karl Dively DDS are for informational purposes only.