NPI | 1043957988 |
---|---|
Doing Business As | GRAND TRAILS DENTAL |
Entity Type | Organization |
Authorized Contact | COURTNEY R MONTEITH Credentialing Coordinator 217-540-8306 |
Organization Subpart ? | Yes |
Primary Taxonomy | 122300000X Dentist |
Enumeration Date | 2022-05-12 |
Last Update Date | 2022-05-12 |