| NPI | 1548706492 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SAROJ KUMAR SAHA Periodontist 309-657-6665 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: CO D00202085) |
| Enumeration Date | 2017-01-17 |
| Last Update Date | 2017-01-17 |