| NPI | 1316499296 |
|---|---|
| Doing Business As | FAMILY DENTAL ON LOUETTA |
| Entity Type | Organization |
| Authorized Contact | CASSANDRA TEUTSCH Credentialing COO Rdinator 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 |