| NPI | 1174945158 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CARLEIGH PRANE Owner 618-624-2800 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IL 19026282) |
| Additional Taxonomies | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment |
| Enumeration Date | 2014-01-10 |
| Last Update Date | 2014-07-03 |