| NPI | 1639196488 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RANDALL CARL WELSER Orthodontist 309-762-8838 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: IL 021-001378) |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2020-08-22 |