| NPI | 1760753362 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSEPH D JACKSON Owner/Dentist 309-764-3242 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IL 19026468) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IL 19015383) |
| Enumeration Date | 2012-01-13 |
| Last Update Date | 2012-01-13 |