| NPI | 1730885393 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HILLARY THULL Credentialing COO Rdiantor 217-540-8946 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery |
| Enumeration Date | 2023-02-06 |
| Last Update Date | 2023-02-06 |