| NPI | 1518170752 |
|---|---|
| Doing Business As | THE DENTIST PLACE FOR KIDS - BROOKSVILLE |
| Entity Type | Organization |
| Authorized Contact | KENDRA WALKER Credentialing Team Lead 217-540-8312 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry |
| Enumeration Date | 2007-05-07 |
| Last Update Date | 2016-05-13 |