NPI | 1366572927 |
---|---|
Entity Type | Organization |
Authorized Contact | CELIA HAYES Credentialing COO Rdinator 217-540-2100 |
Organization Subpart ? | Yes |
Primary Taxonomy | 1223E0200X Dentist Endodontics |
Additional Taxonomies | 1223P0300X Dentist Periodontics |
Enumeration Date | 2007-03-06 |
Last Update Date | 2022-03-14 |