| NPI | 1770632119 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | S MICHAEL VANCIL Member 618-529-3931 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223D0001X Dentist, Dental Public Health (Licence: IL 019017293) |
| Enumeration Date | 2007-01-08 |
| Last Update Date | 2008-07-30 |