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Contact Information

SCOTT M BIETSCH, DMD
402 S LEWIS LN
CARBONDALE, IL62901-3547
 Phone: 618-519-9200
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Dentist

122300000X
 

Pediatric Dentistry

1223P0221X
Indicates primary specialty

NPI Profile & details for SCOTT M BIETSCH · (Male)

NPI # 1902119837
Status Active
Credentials DMD (Doctor of Medical Dentistry)
Entity Individual
Enumeration date 07/20/2010
Last updated 12/09/2016 - About 9 years ago
Sole proprietor 1 No
Identifiers
  • IL License # 019.028399
  • IL License # 021002781
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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