| NPI | 1427549369 |
|---|---|
| Doing Business As | PINE FOREST DENTAL CARE |
| Entity Type | Organization |
| Authorized Contact | CASSANDRA PETERSEN Credentialing Team Lead 217-540-8972 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2018-05-26 |
| Last Update Date | 2019-04-02 |