| NPI | 1679733976 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMY KROEGER Insurance Coordinator 217-540-5100 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| Enumeration Date | 2008-06-11 |
| Last Update Date | 2008-11-12 |