| NPI | 1538597653 |
|---|---|
| Doing Business As | RESERVOIR DENTAL GROUP |
| Entity Type | Organization |
| Authorized Contact | KIM WILSON Cred. Supervisor 217-540-5170 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2013-10-29 |
| Last Update Date | 2013-10-29 |