| NPI | 1851579940 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRUCE RICHARD FEHLMAN Owner 309-944-6401 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IL 060-007047) |
| Enumeration Date | 2008-01-31 |
| Last Update Date | 2008-01-31 |