| NPI | 1124576954 |
|---|---|
| Doing Business As | SEASIDE LIFETIME DENTISTRY |
| Entity Type | Organization |
| Authorized Contact | CASSANDRA N TEUTSCH Credentialing Coordinator 217-540-8972 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2016-09-21 |
| Last Update Date | 2016-09-21 |