| NPI | 1295153641 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRENT DEE BANKHEAD Dr. 618-281-3399 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: IL 019025290) |
| Enumeration Date | 2014-04-02 |
| Last Update Date | 2014-04-02 |