| NPI | 1003107889 |
|---|---|
| Doing Business As | LEE VISTA DENTAL |
| Entity Type | Organization |
| Authorized Contact | PAM HARDIEK Insurance/Credentialing 217-540-5100 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2011-04-27 |
| Last Update Date | 2011-04-27 |