| NPI | 1194157354 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PATRICK RAY VARBLE Vice President 618-498-2232 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: IL 021001893) |
| Enumeration Date | 2013-07-30 |
| Last Update Date | 2013-07-30 |