| NPI | 1578633665 |
|---|---|
| Other Name | CORPORATION |
| Entity Type | Organization |
| Authorized Contact | TED KOESTER Dmd 217-342-4494 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IL 019023257) |
| Enumeration Date | 2006-11-08 |
| Last Update Date | 2020-08-22 |