| NPI | 1629403167 |
|---|---|
| Doing Business As | PRAIRIE DENTAL ASSOCIATES |
| Entity Type | Organization |
| Authorized Contact | DANIEL JACOBSEN Partner 309-662-7722 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IL 019.028635) |
| Enumeration Date | 2013-09-03 |
| Last Update Date | 2013-09-03 |