| NPI | 1497172076 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER HOELSCHER Credentialing COO Rdinator 217-540-5100 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice |
| Enumeration Date | 2014-03-21 |
| Last Update Date | 2014-03-21 |