| NPI | 1902209398 |
|---|---|
| Doing Business As | EVENTIDE FAMILY DENTISTRY |
| Entity Type | Organization |
| Authorized Contact | KIM WILSON Cred Supervisor 217-540-5170 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2014-09-30 |
| Last Update Date | 2014-09-30 |