| NPI | 1639448137 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GERALD RAY DRAGICH President 618-236-0900 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IL 019.017181) |
| Enumeration Date | 2011-12-29 |
| Last Update Date | 2011-12-29 |