| NPI | 1891976825 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROXANNE P BENISON President 618-659-2030 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: IL 021-002093) |
| Enumeration Date | 2007-11-19 |
| Last Update Date | 2007-11-19 |