| NPI | 1740490259 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | INTHUMATHY SIVANANTHAN Dds 815-372-1160 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IL 019023413) |
| Enumeration Date | 2007-05-23 |
| Last Update Date | 2020-08-22 |