NPI | 1114522992 |
---|---|
Former Legal Business Name | MOSAIC DENTAL-EAGAN |
Entity Type | Organization |
Authorized Contact | TABATHA LEMKE Credentialing Coordinator 217-540-6078 |
Organization Subpart ? | Yes |
Primary Taxonomy | 1223G0001X Dentist, General Practice |
Enumeration Date | 2020-12-01 |
Last Update Date | 2020-12-01 |