| NPI | 1124624176 |
|---|---|
| Doing Business As | CHARLESTON RESTORATIVE & COSMETIC DENTISTRY, LLC |
| Entity Type | Organization |
| Authorized Contact | TABATHA LEMKE Credentialing Coordinator 217-540-6078 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2020-12-07 |
| Last Update Date | 2020-12-08 |