| NPI | 1285712653 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLES WILLIAM GROESCH President 217-546-4674 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2020-08-22 |