| NPI | 1932625076 |
|---|---|
| Doing Business As | GRAND DENTAL |
| Entity Type | Organization |
| Authorized Contact | CASSANDRA TEUTSCH Credentialing Coordinator 217-540-8972 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2017-08-21 |
| Last Update Date | 2022-07-21 |