| NPI | 1720260656 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JASON J ALEMAN Member 217-546-9600 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: IL 019012750) |
| Enumeration Date | 2007-12-03 |
| Last Update Date | 2014-01-14 |