| NPI | 1013629930 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | COURTNEY MONTEITH Credentialing COO Rdinator 217-540-8306 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice |
| Enumeration Date | 2022-12-22 |
| Last Update Date | 2022-12-22 |