| NPI | 1811356926 |
|---|---|
| Doing Business As | FOUR LAKES FAMILY DENTAL |
| Entity Type | Organization |
| Authorized Contact | KENDRA WALKER Credentialing Team Lead 217-540-8312 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2016-02-17 |
| Last Update Date | 2016-03-11 |