| NPI | 1164792719 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIMBERLY D HAUG Owner/President 618-463-7002 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: IL 021.001908) |
| Enumeration Date | 2012-01-12 |
| Last Update Date | 2012-01-25 |