NPI | 1205249570 |
---|---|
Doing Business As | SUGARLOAF FAMILY DENTAL |
Entity Type | Organization |
Authorized Contact | KENDRA WALKER Credentialing COO Rdinator 217-540-8312 |
Organization Subpart ? | Yes |
Primary Taxonomy | 1223G0001X Dentist General Practice |
Enumeration Date | 2014-06-04 |
Last Update Date | 2014-06-04 |