| NPI | 1518671304 |
|---|---|
| Doing Business As | BROOKS LAKE DENTAL |
| Entity Type | Organization |
| Authorized Contact | COURTNEY MONTEITH Credentialing Coordinator 217-540-8306 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2023-01-06 |
| Last Update Date | 2023-01-09 |