| NPI | 1851556179 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HARVEY H BRECKNER Dentist 618-206-2396 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: IL 19020061) |
| Enumeration Date | 2008-07-25 |
| Last Update Date | 2008-07-25 |