| NPI | 1053904409 |
|---|---|
| Doing Business As | OLIVE BRANCH DENTAL |
| Entity Type | Organization |
| Authorized Contact | SRINIVAS DURSHANAPALLI Managing Partner 217-303-5955 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice |
| Enumeration Date | 2021-02-17 |
| Last Update Date | 2021-03-03 |