| NPI | 1730399403 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TODD ALAN STOLLER President 309-346-4446 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IL 060.002215) |
| Enumeration Date | 2007-05-23 |
| Last Update Date | 2020-08-22 |