| NPI | 1568475218 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DOUGLAS R. COLTHURST Owner/President 815-344-0453 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IL 060003897) |
| Enumeration Date | 2006-08-14 |
| Last Update Date | 2023-09-06 |