NPI | 1497979918 |
---|---|
Doing Business As | MAIN STREET DENTAL |
Entity Type | Organization |
Authorized Contact | LORI EDMONDS Credentialing Coordinator 217-540-8468 |
Organization Subpart ? | Yes |
Primary Taxonomy | 1223G0001X Dentist, General Practice |
Additional Taxonomies | 1223G0001X Dentist, General Practice |
Enumeration Date | 2007-04-13 |
Last Update Date | 2016-03-29 |