| NPI | 1770791790 |
|---|---|
| Doing Business As | SMOKY HILL DENTAL |
| Entity Type | Organization |
| Authorized Contact | CASSANDRA PETERSEN Credentialing Team Lead 217-540-8972 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CO CO7282) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CO CO7099) |
| Enumeration Date | 2007-05-21 |
| Last Update Date | 2018-11-14 |