| NPI | 1790970200 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KORY M MELIN Dentist 309-796-2251 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IL 019023972) |
| Enumeration Date | 2007-09-07 |
| Last Update Date | 2007-09-07 |