| NPI | 1356516389 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAMELA S HARDIEK Credentialing Coordinator 217-540-5100 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2008-04-30 |
| Last Update Date | 2011-04-11 |