| NPI | 1851498059 |
|---|---|
| Doing Business As | PLAZA BOULEVARD DENTAL |
| Doing Business As | ROUSSEAU FAMILY DENTISTRY |
| Entity Type | Organization |
| Authorized Contact | HEATHER PRUEMER Credentialing Team Lead 217-540-8434 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2017-08-01 |