Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 019018274 | IL |
NPI | 1336445253 |
---|---|
Provider Name | Dr. Ronnie Mccuan |
First Address | Harrisburg, IL 62946-2201 |
Second Address | Carterville, IL 62918-2500 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/02/2011 |
Last Update Date | 10/02/2011 |