| NPI | 1619192614 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMY M KROEGER Insurance COO Rdinator 217-540-5100 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: FL DN 7363) |
| Enumeration Date | 2007-04-16 |
| Last Update Date | 2008-01-18 |