| NPI | 1205531431 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN PERISIN Owner 309-369-7235 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice |
| Additional Taxonomies | 261QD0000X Clinic/Center Dental |
| Enumeration Date | 2023-04-05 |
| Last Update Date | 2023-04-05 |