| NPI | 1730676990 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALEX MOORE Dentist 815-621-6060 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2018-04-13 |
| Last Update Date | 2022-04-21 |