| NPI | 1154631075 |
|---|---|
| Doing Business As | FDC - MAPLE LAWN |
| Entity Type | Organization |
| Authorized Contact | CARMEN WOODS Insurance/Credentialing 217-540-5100 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice |
| Enumeration Date | 2010-10-13 |
| Last Update Date | 2021-11-06 |