| NPI | 1104387489 |
|---|---|
| Doing Business As | EAST AVENUE DENTAL CARE |
| Entity Type | Organization |
| Authorized Contact | TABATHA LEMKE Credentialing Coordinator 217-540-6078 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2019-03-28 |
| Last Update Date | 2019-03-28 |