| NPI | 1568602266 |
|---|---|
| Doing Business As | STANDLEY SHORES DENTAL GROUP |
| Entity Type | Organization |
| Authorized Contact | CASSANDRA TEUTSCH Credentialing Coordinator 217-540-8972 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CO 105399) |
| Enumeration Date | 2009-02-20 |
| Last Update Date | 2017-07-17 |