| NPI | 1790990422 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEVEN W SEIBERT President 217-398-4867 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: IL 021001261) |
| Enumeration Date | 2007-05-14 |
| Last Update Date | 2016-10-25 |