| NPI | 1346739372 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DANA E FENDER Owner 217-356-2222 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: IL 19.031054) |
| Enumeration Date | 2018-05-04 |
| Last Update Date | 2020-10-13 |