| NPI | 1558128058 |
|---|---|
| Doing Business As | COASTAL COSMETIC DENTAL |
| Entity Type | Organization |
| Authorized Contact | HILLARY THULL Credentialing COO Rdinator 217-540-8946 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice |
| Enumeration Date | 2024-03-01 |
| Last Update Date | 2024-04-08 |