| NPI | 1447415757 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HARVEY H BRECKNER Dentist 618-307-3267 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: IL 19020061) |
| Enumeration Date | 2008-07-25 |
| Last Update Date | 2008-07-25 |