| NPI | 1265562631 |
|---|---|
| Doing Business As | FORWARDDENTAL GLENDALE |
| Entity Type | Organization |
| Authorized Contact | CELIA HAYES Credentialing Coordinator 217-540-2100 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry |
| Enumeration Date | 2007-03-06 |
| Last Update Date | 2022-04-15 |