| NPI | 1780897009 |
|---|---|
| Doing Business As | SOUTH STREET FAMILY DENTAL |
| Entity Type | Organization |
| Authorized Contact | AMY KROEGER Ins Cood 217-540-5100 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2007-05-07 |
| Last Update Date | 2020-08-22 |