| NPI | 1730827841 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | COURTNEY MONTEITH Credentialing COO Rdinator 217-540-8306 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice |
| Enumeration Date | 2022-05-27 |
| Last Update Date | 2022-05-27 |