| NPI | 1750641338 |
|---|---|
| Doing Business As | MYCROSSROADSDENTIST |
| Entity Type | Organization |
| Authorized Contact | KENDRA WALKER Credentialing Team Lead 217-540-8513 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2012-05-17 |
| Last Update Date | 2018-04-25 |