| NPI | 1821462052 |
|---|---|
| Doing Business As | SOUTHERN ILLINOIS PEDIATRIC DENTISTRY |
| Entity Type | Organization |
| Authorized Contact | CHRISTINE ANNE WOHLFORD Owner/Member 618-791-2794 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: IL 019028314) |
| Enumeration Date | 2015-11-27 |
| Last Update Date | 2015-11-27 |