| NPI | 1477981652 |
|---|---|
| Doing Business As | MISSION LAKES DENTAL CARE |
| Entity Type | Organization |
| Authorized Contact | ALLISON VARNER Credentialing Coordinator 217-540-6077 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DN20221) |
| Enumeration Date | 2013-10-24 |
| Last Update Date | 2013-10-24 |