| NPI | 1588204309 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANGIE GUNTHER Treatment COO Rdinator 309-343-8727 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2020-01-09 |
| Last Update Date | 2020-01-09 |