| NPI | 1235250200 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRADLEY J LUTCHKA Oral Surgeon 309-797-1770 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: 060000189) |
| Enumeration Date | 2007-04-03 |
| Last Update Date | 2020-09-24 |