| NPI | 1568816155 |
|---|---|
| Doing Business As | CORNER LAKE FAMILY DENTAL |
| Entity Type | Organization |
| Authorized Contact | KENDRA WALKER Credentialing Team Lead 217-540-8312 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2016-04-20 |
| Last Update Date | 2016-09-23 |