| NPI | 1588100325 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFFREY ROGER STEVENSON Dentist 217-342-3850 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IL 019023431) |
| Enumeration Date | 2017-01-18 |
| Last Update Date | 2017-01-18 |