| NPI | 1134542376 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LINDSEY A HANS Owner 217-356-9855 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: IL 0193027486) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| Enumeration Date | 2014-01-23 |
| Last Update Date | 2019-01-28 |