| NPI | 1245450378 |
|---|---|
| Doing Business As | PRODENTAL |
| Entity Type | Organization |
| Authorized Contact | KENDRA WALKER Credentialing Team Lead 217-540-8513 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2007-04-30 |
| Last Update Date | 2018-04-25 |