| NPI | 1629186713 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFFREY TODD BRUNSON Owner 217-352-9688 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: IL 060001223) |
| Enumeration Date | 2006-08-28 |
| Last Update Date | 2008-06-23 |