NPI | 1164027306 |
---|---|
Doing Business As | FORUM DENTAL - ST. ROBERT |
Entity Type | Organization |
Authorized Contact | JESSICA BRITT Credentialing Coordinator 217-540-8426 |
Organization Subpart ? | Yes |
Primary Taxonomy | 1223G0001X Dentist, General Practice |
Enumeration Date | 2020-12-04 |
Last Update Date | 2020-12-04 |