| NPI | 1134491657 |
|---|---|
| Doing Business As | MYNORTHATLANTADENTIST.COM |
| Entity Type | Organization |
| Authorized Contact | KIM WILSON Insurance/Credentialing 217-540-5100 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2012-01-30 |
| Last Update Date | 2012-01-30 |