| NPI | 1750405445 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMES STOVALL Owner 815-397-7454 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IL 060.008981) |
| Enumeration Date | 2007-03-19 |
| Last Update Date | 2020-08-22 |