| NPI | 1447472790 |
|---|---|
| Doing Business As | COLLEGE AVENUE FAMILY DENTISTRY |
| Entity Type | Organization |
| Authorized Contact | LINDSAY BEARDEN Ins COO D 217-540-5100 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice |
| Enumeration Date | 2007-05-03 |
| Last Update Date | 2014-01-07 |