| NPI | 1790906139 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENNETH DELAINE MEISS President 309-682-9802 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IL 019-024524) |
| Enumeration Date | 2007-05-02 |
| Last Update Date | 2015-02-20 |