| NPI | 1639551278 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CELIA HAYES Credentialing COO Rdinator 217-540-2100 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: WI 3157) |
| Enumeration Date | 2015-06-19 |
| Last Update Date | 2022-03-14 |