| NPI | 1568046969 |
|---|---|
| Doing Business As | INNOVATIVE ORTHODONTIC CENTERS |
| Entity Type | Organization |
| Authorized Contact | TABATHA LEMKE Credentialing Coordinator 217-540-6078 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Additional Taxonomies | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2021-05-11 |
| Last Update Date | 2021-06-04 |