| NPI | 1891159299 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOY S MARTIN Corporate Secretary 217-355-9997 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IL 060007408) |
| Enumeration Date | 2016-04-12 |
| Last Update Date | 2016-04-12 |