| NPI | 1124736590 |
|---|---|
| Doing Business As | CARILLON PARK DENTAL |
| Entity Type | Organization |
| Authorized Contact | COURTNEY MONTEITH Credentialing Coordinator 217-540-8306 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2022-11-14 |
| Last Update Date | 2022-11-23 |