| 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 |