| NPI | 1326251869 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRADLEY WILLIAM BARNES Owner 309-454-7337 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IL 019019725) |
| Enumeration Date | 2007-05-08 |
| Last Update Date | 2020-08-22 |