Provider Demographics
NPI:1871304055
Name:EFFINGHAM ENDODONTIST
Entity type:Organization
Organization Name:EFFINGHAM ENDODONTIST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER ENDODONTIST
Authorized Official - Prefix:
Authorized Official - First Name:CLAIRE
Authorized Official - Middle Name:CHRISTINE
Authorized Official - Last Name:LUSTIG
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:217-663-6292
Mailing Address - Street 1:2005 ARSENAL ST
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63118-2535
Mailing Address - Country:US
Mailing Address - Phone:217-663-6292
Mailing Address - Fax:
Practice Address - Street 1:107 S 3RD ST LOWR LEVEL
Practice Address - Street 2:
Practice Address - City:EFFINGHAM
Practice Address - State:IL
Practice Address - Zip Code:62401-3632
Practice Address - Country:US
Practice Address - Phone:217-663-6292
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-16
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty