| NPI | 1396135216 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENDRA WALKER Credentialing COO Rdinator 217-540-8312 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: GA DN012289) |
| Enumeration Date | 2015-01-30 |
| Last Update Date | 2016-05-25 |