| NPI | 1891884920 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CARL DAVID BRICKMAN Owner 618-462-1081 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: IL 021-001903) |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2020-08-22 |