| NPI | 1609176999 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GINA LEIGH GROSSE General Dentist 309-472-0645 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IL 019027794) |
| Enumeration Date | 2010-11-02 |
| Last Update Date | 2010-11-02 |