| NPI | 1518239268 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ERIN N DUMSTORFF Office Manager 618-235-9101 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center Dental (Licence: IL 019013509) |
| Enumeration Date | 2012-01-27 |
| Last Update Date | 2012-01-27 |