NPI | 1952062788 |
---|---|
Doing Business As | AMERICAN FAMILY DENTISTRY MOUNTAIN GROVE |
Entity Type | Organization |
Authorized Contact | CELIA HAYES Credentialing Coordinator 217-540-2100 |
Organization Subpart ? | Yes |
Primary Taxonomy | 1223G0001X Dentist, General Practice |
Enumeration Date | 2022-01-04 |
Last Update Date | 2022-01-04 |