NPI | 1316499296 |
---|---|
Doing Business As | FAMILY DENTAL ON LOUETTA |
Entity Type | Organization |
Authorized Contact | CASSANDRA TEUTSCH Credentialing Coordinator 217-540-8972 |
Organization Subpart ? | Yes |
Primary Taxonomy | 1223G0001X Dentist, General Practice |
Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
Enumeration Date | 2016-10-26 |
Last Update Date | 2018-09-10 |