NPI | 1619619129 |
---|---|
Doing Business As | CENTRAL AVENUE DENTAL CARE |
Entity Type | Organization |
Authorized Contact | CELIA HAYES Credentialing Coordinator 217-540-2100 |
Organization Subpart ? | Yes |
Primary Taxonomy | 1223G0001X Dentist, General Practice |
Enumeration Date | 2022-04-13 |
Last Update Date | 2024-02-01 |