| NPI | 1649305921 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACQUELYN LEAH RICHARDSON President Dentist 309-762-3015 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: IL 019026572) |
| Enumeration Date | 2007-02-23 |
| Last Update Date | 2008-06-25 |