| NPI | 1386035467 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LEONOR CECILIA VILLALTA Managing Dentist 217-722-4565 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: IL 019029681) |
| Enumeration Date | 2015-02-11 |
| Last Update Date | 2015-02-11 |