NPI | 1215912696 |
---|---|
Entity Type | Organization |
Authorized Contact | DEBRA M SCHWENK Associate Dean For Clinical Affairs 618-474-7080 |
Organization Subpart ? | No |
Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: IL 19018978) |
Enumeration Date | 2005-12-08 |
Last Update Date | 2007-07-10 |