| NPI | 1891897799 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLY JAMES MOORE Dentist/Owner 815-399-9040 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IL 060-003341) |
| Enumeration Date | 2006-09-01 |
| Last Update Date | 2008-10-10 |