| NPI | 1083706543 |
|---|---|
| Doing Business As | NORTH WASHINGTON DENTAL |
| Entity Type | Organization |
| Authorized Contact | CASSANDRA PETERSEN Credentialing Team Lead 217-540-8972 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: CO 6850) |
| Additional Taxonomies | 122300000X Dentist (Licence: CO 0218) |
| 122300000X Dentist (Licence: CO 104242) | |
| 122300000X Dentist (Licence: CO 105657) | |
| Enumeration Date | 2006-09-29 |
| Last Update Date | 2023-09-07 |