NPI | 1104566728 |
---|---|
Doing Business As | FAMILY DENTISTRY ON LACEY |
Entity Type | Organization |
Authorized Contact | HILLARY THULL Credentialing Coordinator 217-540-8946 |
Organization Subpart ? | Yes |
Primary Taxonomy | 1223G0001X Dentist, General Practice |
Enumeration Date | 2022-03-31 |
Last Update Date | 2022-04-13 |