| NPI | 1699815498 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMES A BOGGESS CEO 217-793-9550 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IL 019022685) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019023967) |
| Enumeration Date | 2007-02-08 |
| Last Update Date | 2020-08-22 |