| NPI | 1356555155 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DANA C. GRAY President 217-359-3112 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IL 060003267) |
| Enumeration Date | 2007-05-10 |
| Last Update Date | 2012-11-19 |