| NPI | 1649308230 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JERRY LEE MARSHALL Director Of Dental Services 309-382-2229 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251K00000X Public Health or Welfare (Licence: IL E9993-0978-05) |
| Enumeration Date | 2007-03-02 |
| Last Update Date | 2008-06-20 |