| NPI | 1851697643 |
|---|---|
| Doing Business As | BROAD STREET DENTAL CARE |
| Entity Type | Organization |
| Authorized Contact | KIM ZUBER Cred Sup 217-540-5170 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: AL 4762) |
| Additional Taxonomies | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment (Licence: AL 4762) |
| Enumeration Date | 2011-01-27 |
| Last Update Date | 2019-11-08 |