| 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 |