| NPI | 1174699797 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CATHERINE L GOOD Owner 309-627-2914 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IL 019026533) |
| Additional Taxonomies | 124Q00000X Dental Hygienist (Licence: IL 020008467) |
| 126800000X Dental Assistant | |
| Enumeration Date | 2006-11-27 |
| Last Update Date | 2020-08-22 |