| NPI | 1710007836 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIRK WILLIAM NORAIAN Owner 309-663-4577 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IL 019-021623) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: IL 021-001562) |
| Enumeration Date | 2007-03-30 |
| Last Update Date | 2020-08-22 |