NPI | 1942717228 |
---|---|
Doing Business As | RESTORATION DENTAL |
Entity Type | Organization |
Authorized Contact | KYE EDWARD MALLERNEE Dentist 217-619-1059 |
Organization Subpart ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 31328) |
Enumeration Date | 2018-01-08 |
Last Update Date | 2018-01-08 |