| NPI | 1588612386 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAY IVOR SWANSON President 217-342-4444 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: IL 019019384) |
| Enumeration Date | 2006-05-04 |
| Last Update Date | 2013-03-04 |