| NPI | 1477066652 |
|---|---|
| Doing Business As | DENTISTRY ON WALNUT GROVE |
| Entity Type | Organization |
| Authorized Contact | JESSICA BRITT Credentialing Coordinator 217-540-8426 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2017-11-10 |
| Last Update Date | 2017-11-10 |