| NPI | 1518000892 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID BRADFORD RODENBERG President 618-281-7137 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IL 019018875) |
| Enumeration Date | 2007-02-15 |
| Last Update Date | 2020-08-22 |