| NPI | 1023430261 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALLISON VARNER Credentialing COO Rdinator 217-540-6077 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DN20237) |
| Enumeration Date | 2014-01-07 |
| Last Update Date | 2014-01-07 |