| NPI | 1457475527 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK BRYAN HULS Orthodontist 217-352-4334 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: IL 019025032) |
| Enumeration Date | 2007-03-16 |
| Last Update Date | 2020-08-22 |