| NPI | 1356002778 |
|---|---|
| Doing Business As | OLIVE BRANCH DENTAL LAFAYETTE RD |
| Entity Type | Organization |
| Authorized Contact | SRINIVAS DURSHANAPALLI President 217-303-5955 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2022-01-07 |
| Last Update Date | 2022-01-07 |