| NPI | 1669824439 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BENJAMIN JACOB SCHLOTT Single Member 618-462-1646 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: IL 021002736) |
| Enumeration Date | 2016-07-06 |
| Last Update Date | 2022-10-26 |