| NPI | 1750780219 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CANDACE CHRISTINE CUMMINS Treasurer/Bookkeeper 217-381-3681 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2014-08-20 |
| Last Update Date | 2015-02-05 |