| NPI | 1659545762 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROSA D. BELLIDO-GRIFFIN Dental COO Rdinator 815-337-5616 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223D0001X Dentist Dental Public Health |
| Additional Taxonomies | 1223D0001X Dentist Dental Public Health |
| Enumeration Date | 2008-04-18 |
| Last Update Date | 2016-02-29 |