| NPI | 1912109646 |
|---|---|
| Doing Business As | CREATIVE SMILES AT WINGHAVEN |
| Entity Type | Organization |
| Authorized Contact | KENDRA WALKER Credentialing Team Lead 217-540-8513 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2007-06-04 |
| Last Update Date | 2018-04-24 |