| NPI | 1497404818 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CELIA HAYES Credentialing COO Rdinator 217-540-2100 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223P0106X Dentist Oral and Maxillofacial Pathology |
| Enumeration Date | 2022-03-22 |
| Last Update Date | 2022-03-22 |