| NPI | 1114453081 |
|---|---|
| Doing Business As | ENERGY SQUARE DENTAL |
| Entity Type | Organization |
| Authorized Contact | CASSANDRA NICHOLE TEUTSCH Credentialing Coordinator 217-540-8972 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2017-05-11 |
| Last Update Date | 2017-06-26 |