| NPI | 1538295522 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RANDALL J CRAMMOND President 618-462-1646 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: IL 060005105) |
| Enumeration Date | 2007-02-26 |
| Last Update Date | 2020-08-22 |