| NPI | 1740468305 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BELINDA HUERTA Credentialing COO Rdinator 217-540-2100 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: OK 3831) |
| Enumeration Date | 2008-02-06 |
| Last Update Date | 2023-03-15 |