| NPI | 1750503371 |
|---|---|
| Doing Business As | ST. CHARLES LIFETIME DENTAL |
| Entity Type | Organization |
| Authorized Contact | KIM ZUBER I & R Supervisor 217-540-5170 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IL 019029509) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2007-05-03 |
| Last Update Date | 2016-10-20 |