| NPI | 1033366844 |
|---|---|
| Doing Business As | DENTAL EXCELLENCE OF SAND LAKE |
| Entity Type | Organization |
| Authorized Contact | PAM HARDIEK Insurance / Credentialing 217-540-5100 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2008-08-22 |
| Last Update Date | 2008-08-22 |