| NPI | 1598003832 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CELIA HAYES Credentialing COO Rdinator 217-540-2100 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice |
| Additional Taxonomies | 261QD0000X Clinic/Center Dental (Licence: OH 14417) |
| Enumeration Date | 2013-01-22 |
| Last Update Date | 2022-02-11 |