| NPI | 1548557002 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HEATHER N. PRUEMER Credentialing COO Rdinator 217-540-8434 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice |
| Enumeration Date | 2011-07-06 |
| Last Update Date | 2015-09-15 |