| NPI | 1942668199 |
|---|---|
| Doing Business As | DEVINE DENTISTRY |
| Entity Type | Organization |
| Authorized Contact | HEATER PRUEMER Credentialing Team Lead 217-540-8434 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2016-02-03 |
| Last Update Date | 2016-02-03 |