| NPI | 1316598311 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TANYA L DESANTO Dentist/Owner 217-546-0412 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment |
| Additional Taxonomies | 122300000X Dentist |
| Enumeration Date | 2019-09-23 |
| Last Update Date | 2019-10-16 |