| NPI | 1427300326 |
|---|---|
| Doing Business As | LAKE GIBSON DENTAL CENTER |
| Entity Type | Organization |
| Authorized Contact | MARIE KUHL Credentialing Manager 217-540-5100 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2012-10-03 |
| Last Update Date | 2012-10-03 |