| NPI | 1104253186 |
|---|---|
| Doing Business As | BROADLANDS COMPLETE DENTAL |
| Entity Type | Organization |
| Authorized Contact | LINDSAY BEARDEN Insurane/Credentialing 217-540-5100 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2013-10-04 |
| Last Update Date | 2014-01-11 |