| NPI | 1487919866 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CYNTHIA PAIGE MCCORD Owner 309-772-2124 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IL 019-028904) |
| Additional Taxonomies | 124Q00000X Dental Hygienist (Licence: IL 020-010827) |
| Enumeration Date | 2012-07-11 |
| Last Update Date | 2012-07-11 |