| NPI | 1093931784 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RICHARD THOMAS MOON Dentist 309-691-7855 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IL 019018071) |
| Enumeration Date | 2007-04-18 |
| Last Update Date | 2020-08-22 |