| NPI | 1710582952 |
|---|---|
| Doing Business As | FORUM DENTAL - ROLLA |
| Entity Type | Organization |
| Authorized Contact | JESSICA BRITT Credentialing Coordinator 217-540-8426 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2020-12-04 |
| Last Update Date | 2020-12-04 |