| NPI | 1104373240 |
|---|---|
| Doing Business As | THOMASVILLE ROAD DENTAL CARE |
| Entity Type | Organization |
| Authorized Contact | KENDRA W Credentialing Team Lead 217-540-8312 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2016-09-07 |
| Last Update Date | 2017-01-09 |