NPI | 1740041771 |
---|---|
Doing Business As | SOUTHSIDE VILLAGE DENTAL CARE |
Entity Type | Organization |
Authorized Contact | HILLARY THULL Credentialing Coordinator 217-540-8946 |
Organization Subpart ? | Yes |
Primary Taxonomy | 1223G0001X Dentist, General Practice |
Enumeration Date | 2024-01-17 |
Last Update Date | 2024-01-17 |