| NPI | 1003168485 |
|---|---|
| Doing Business As | PLUM DRIVE DENTAL |
| Doing Business As | GATEWAY FAMILY DENTAL |
| Entity Type | Organization |
| Authorized Contact | BELINDA HUERTA Credentialing Coordinator 217-540-5100 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2012-10-09 |
| Last Update Date | 2023-03-15 |