| NPI | 1871913293 |
|---|---|
| Doing Business As | MYDENTIST-LEWISVILLE PERIO |
| Entity Type | Organization |
| Authorized Contact | KENDRA WALKER Credentialing Coordinator 217-540-8312 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics |
| Enumeration Date | 2014-04-24 |
| Last Update Date | 2014-04-24 |