| NPI | 1811079866 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHEN EDWARD DICKEY President Owner 309-347-7055 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IL 019023193) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019019439) |
| 122300000X Dentist (Licence: IL 05915931) | |
| Enumeration Date | 2006-10-19 |
| Last Update Date | 2020-08-22 |