| NPI | 1871994723 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER SUZANNE PRITTS Dentist/President 217-224-0426 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: IL 019-027702) |
| Enumeration Date | 2014-09-10 |
| Last Update Date | 2014-09-10 |