| NPI | 1902251911 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MINDY SCHMACHT Office Manager 217-971-3432 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IL 019.0228802) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019.030202) |
| Enumeration Date | 2016-04-27 |
| Last Update Date | 2016-04-27 |