| NPI | 1821788936 |
|---|---|
| Doing Business As | PREMIER ENDODONTICS OF SOUTHPARK |
| Entity Type | Organization |
| Authorized Contact | KATIE R KICKERTZ Owner Dentist 815-222-2102 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics |
| Enumeration Date | 2023-05-11 |
| Last Update Date | 2023-05-11 |