| NPI | 1306902499 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN EWARD DONLAN Owner 309-691-9421 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IL 019023386) |
| Enumeration Date | 2006-12-31 |
| Last Update Date | 2008-09-05 |