| NPI | 1083767396 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAURA J DONLAN President 309-692-0175 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IL 19023606) |
| Enumeration Date | 2007-01-19 |
| Last Update Date | 2020-08-22 |