| NPI | 1801517743 |
|---|---|
| Doing Business As | PRAIRIE DENTAL GROUP |
| Entity Type | Organization |
| Authorized Contact | ROBIN HAYES Office Manager 217-546-0412 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Enumeration Date | 2022-09-08 |
| Last Update Date | 2022-10-04 |