| NPI | 1467450783 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BARBARA J NELSON Office Manager Corporate Secretary 842-895-4513 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: IL 019013534) |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental (Licence: IL 019015937) |
| Enumeration Date | 2005-07-11 |
| Last Update Date | 2020-08-22 |