| NPI | 1407132822 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BELINDA HUERTA Credentialing COO Rdinator 217-540-2100 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice |
| Additional Taxonomies | 1223P0221X Dentist Pediatric Dentistry (Licence: TX 13687) |
| Enumeration Date | 2011-10-31 |
| Last Update Date | 2024-04-25 |