| NPI | 1780012591 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER HOELSCHER Insurance/Credentialing 217-540-5100 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice |
| Enumeration Date | 2013-10-15 |
| Last Update Date | 2013-10-15 |