| NPI | 1720458177 |
|---|---|
| Doing Business As | OLDE MILL FAMILY DENTAL |
| Entity Type | Organization |
| Authorized Contact | KENDRA WALKER Credentialing Coordinator 217-540-8312 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2015-09-29 |
| Last Update Date | 2015-11-04 |