| NPI | 1558814897 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RYAN MOORE Dentist 815-399-0677 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IL 019.030757) |
| Enumeration Date | 2016-08-03 |
| Last Update Date | 2016-08-03 |