| NPI | 1376673533 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CELIA HAYES Credentialing COO Rdinator 217-540-2100 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2007-03-06 |
| Last Update Date | 2022-03-14 |