| NPI | 1023502986 |
|---|---|
| Doing Business As | GRAND LELY DENTAL CARE |
| Entity Type | Organization |
| Authorized Contact | JESSICA BRITT Credentialing Coordinator 217-540-8426 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2018-06-14 |
| Last Update Date | 2018-09-18 |