| NPI | 1639552284 |
|---|---|
| Doing Business As | BAYSIDE DENTAL CARE |
| Entity Type | Organization |
| Authorized Contact | JASMINE REARDON Credentialing Coordinator 217-540-8330 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 122300000X Dentist |
| Enumeration Date | 2015-07-01 |
| Last Update Date | 2015-07-01 |