NPI | 1477112340 |
---|---|
Doing Business As | CHERRY WAY DENTAL |
Entity Type | Organization |
Authorized Contact | TABATHA LEMKE Credentialing 217-540-6078 |
Organization Subpart ? | Yes |
Primary Taxonomy | 1223G0001X Dentist, General Practice |
Enumeration Date | 2019-06-13 |
Last Update Date | 2019-06-13 |