| NPI | 1720392616 |
|---|---|
| Doing Business As | MYONTARIODENTIST.COM |
| Entity Type | Organization |
| Authorized Contact | KENDRA WALKER Credentialing Coordinator 217-540-5100 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2010-08-03 |
| Last Update Date | 2014-05-09 |