| 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 |