| NPI | 1275353989 |
|---|---|
| Doing Business As | MAIN STREET DENTAL CARE |
| Entity Type | Organization |
| Authorized Contact | CEMYIRA MCDOUGAL Credentialing Coordinator 217-764-8609 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 122300000X Dentist |
| Enumeration Date | 2024-10-16 |
| Last Update Date | 2024-12-04 |