| NPI | 1558870188 |
|---|---|
| Doing Business As | ADVANCED DENTAL ON SMOKY HILL ROAD |
| Entity Type | Organization |
| Authorized Contact | CASSANDRA PETERSEN Credentialing Coordinator 217-540-8972 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2017-09-27 |
| Last Update Date | 2017-09-27 |