| NPI | 1750551339 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SCOTT MICHAEL WOLTER President 618-462-7471 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IL 019-022226) |
| Enumeration Date | 2008-03-10 |
| Last Update Date | 2008-03-10 |