| NPI | 1619387586 |
|---|---|
| Doing Business As | WILLOW BEND DENTAL |
| Entity Type | Organization |
| Authorized Contact | KIM WILSON Cred. Supervisor 217-540-5170 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2014-05-01 |
| Last Update Date | 2014-05-01 |