| NPI | 1366502825 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROSEANNE BRUNENKANT Office Manager 309-274-6237 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IL 019013646) |
| Enumeration Date | 2006-12-12 |
| Last Update Date | 2012-04-26 |