| NPI | 1487057162 |
|---|---|
| Doing Business As | GREAT SOUTHERN SMILES |
| Entity Type | Organization |
| Authorized Contact | BELINDA HUERTA Credentialing COO Rdinator 217-540-2100 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice |
| Enumeration Date | 2014-10-08 |
| Last Update Date | 2023-03-15 |