| NPI | 1386922235 |
|---|---|
| Doing Business As | FAIRWATER DENTAL GROUP |
| Entity Type | Organization |
| Authorized Contact | PAM HARDIEK Insurance/Credentialing 217-540-5100 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2011-07-26 |
| Last Update Date | 2011-07-26 |