Poonam Jain
Dentist, General Practice in Staunton, IL. Individual provider (NPI-1).
NPI number1790799385
StatusActive
Last updated in NPPESJan 8, 2025
Details
- NPI
- 1790799385
- Entity type
- Individual (NPI-1)
- Name
- Poonam Jain
- Sex
- Female
- Sole proprietor
- Yes
- Enumeration date
- Jul 28, 2006
- Certification date
- Jan 8, 2025
- Last updated
- Jan 8, 2025
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1223G0001X | Dentist, General Practice | 019-024969 | IL | Yes |
Practice location
109 W Main StStaunton, IL 62088-1452
Phone 618-635-2280 · Fax 618-635-2902
Mailing address
5 Evergreen DrStaunton, IL 62088-2217
Phone 618-978-1847
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