| NPI | 1689792038 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DALE EDWARD FEHR Orthodontist 309-751-3080 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: IL 019.022448) |
| Enumeration Date | 2007-03-26 |
| Last Update Date | 2020-08-22 |