| NPI | 1760130280 |
|---|---|
| Doing Business As | FORWARDDENTAL BAYSHORE |
| Entity Type | Organization |
| Authorized Contact | CELIA HAYES Credentialing Coordinator 217-540-2100 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2022-03-14 |
| Last Update Date | 2022-03-14 |