| NPI | 1144534843 |
|---|---|
| Doing Business As | SAND LAKE CENTRE FOR ADVANCED DENTISTRY |
| Entity Type | Organization |
| Authorized Contact | PAM HARDIEK Insurance / Credentialing 217-540-5100 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 122300000X Dentist |
| Enumeration Date | 2010-08-05 |
| Last Update Date | 2010-08-05 |