| NPI | 1083479703 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RHIANNON MICHELLE HOLCOMBE Owner 815-267-7299 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2024-02-21 |
| Last Update Date | 2024-02-21 |