| NPI | 1518290196 |
|---|---|
| Doing Business As | SOUTHEAST DENTAL GROUP |
| Entity Type | Organization |
| Authorized Contact | KAM SHICK Insurance/Credentialing 217-540-5100 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2009-09-14 |
| Last Update Date | 2009-09-14 |