NPI | 1184839276 |
---|---|
Doing Business As | THUNDER MOUNTAIN DENTISTRY |
Entity Type | Organization |
Authorized Contact | AMY KROEGER Ins Cood 217-540-5100 |
Organization Subpart ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice |
Enumeration Date | 2007-05-11 |
Last Update Date | 2020-08-22 |