| NPI | 1477009520 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CASSANDRA TEUTSCH Credentialing COO Rdinator 217-540-8972 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice |
| Enumeration Date | 2016-08-29 |
| Last Update Date | 2016-08-29 |