| NPI | 1942475835 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRIAN CHAUNCEY CROSS President Of Corporation 217-787-0212 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IL 019020191) |
| Enumeration Date | 2008-04-23 |
| Last Update Date | 2008-04-23 |