NPI | 1043340417 |
---|---|
Doing Business As | FORWARDDENTAL RIVERCENTER |
Entity Type | Organization |
Authorized Contact | CELIA HAYES Credentialing Coordinator 217-540-2100 |
Organization Subpart ? | Yes |
Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry |
Enumeration Date | 2007-03-06 |
Last Update Date | 2022-04-15 |