| NPI | 1215674163 |
|---|---|
| Doing Business As | MARYSVILLE PERIODONTAL AND IMPLANT CENTER |
| Entity Type | Organization |
| Authorized Contact | COURTNEY R MONTEITH Credentialing COO Rdinator 217-540-8306 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist Periodontics |
| Enumeration Date | 2022-05-12 |
| Last Update Date | 2022-06-03 |