| NPI | 1215315312 |
|---|---|
| Doing Business As | FAMILY DENTISTRY OF NORTHLAKE |
| Entity Type | Organization |
| Authorized Contact | KIM WILSON Cred Sup 217-540-5170 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2015-05-11 |
| Last Update Date | 2015-05-11 |