NPI | 1285184259 |
---|---|
Entity Type | Organization |
Authorized Contact | GREGORY M DIETZ Owner & Provider 309-827-5437 |
Organization Subpart ? | No |
Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: IL 021002544) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IL 019027386) |
1223G0001X Dentist, General Practice | |
Enumeration Date | 2016-10-13 |
Last Update Date | 2021-05-28 |