| NPI | 1285754697 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DANA RICE Financial Business Manager 217-649-9491 |
| Organization Subpart ? | |
| Primary Taxonomy | 261QD0000X Clinic/Center Dental (Licence: IL 060-007960) |
| Enumeration Date | 2007-03-30 |
| Last Update Date | 2014-04-29 |