| NPI | 1134494289 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PHILLIP JENSEN President 217-753-8690 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: IL 019020843) |
| Enumeration Date | 2012-03-21 |
| Last Update Date | 2012-03-21 |