| NPI | 1669540399 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMY M KROEGER Insurance COO Rdinator 217-540-5100 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery |
| Enumeration Date | 2006-12-01 |
| Last Update Date | 2023-08-23 |