| NPI | 1770116790 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SAMSON LIU Manager 217-821-7960 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2020-02-18 |
| Last Update Date | 2020-02-20 |