| NPI | 1467674770 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN PETER VAN SCOYOC President 309-664-0570 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IL 060007912) |
| Enumeration Date | 2007-05-03 |
| Last Update Date | 2020-08-22 |