NPI | 1104218361 |
---|---|
Doing Business As | ELITE DENTISTRY |
Entity Type | Organization |
Authorized Contact | KIM WILSON Cred Sup 217-540-5170 |
Organization Subpart ? | Yes |
Primary Taxonomy | 1223G0001X Dentist, General Practice |
Enumeration Date | 2015-02-25 |
Last Update Date | 2015-02-25 |