| NPI | 1275606592 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN BRUCE DALE Doctor 309-691-9100 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: IL 021.002048) |
| Enumeration Date | 2006-11-16 |
| Last Update Date | 2012-01-30 |