| NPI | 1013302785 |
|---|---|
| Doing Business As | ASHBY PARK RESTORATIVE AND COSMETIC DENTISTRY PA |
| Entity Type | Organization |
| Authorized Contact | CASSANDRA PETERSEN Credentialing Team Lead 217-540-8972 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: SC 3791) |
| Enumeration Date | 2015-03-31 |
| Last Update Date | 2018-05-07 |