| NPI | 1437895778 |
|---|---|
| Doing Business As | ARTESIAN DENTAL ON LACEY BOULEVARD |
| Entity Type | Organization |
| Authorized Contact | COURTNEY R MONTEITH Credentialing Coordinator 217-540-8306 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2022-05-10 |
| Last Update Date | 2022-05-10 |