| NPI | 1952635930 |
|---|---|
| Doing Business As | BANYAN DENTAL CARE |
| Doing Business As | TAMIAMI TRAIL DENTAL CARE |
| Entity Type | Organization |
| Authorized Contact | CASSANDRA PETERSEN Credentialing Team Lead 217-540-8972 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: Fl8320/Fl9455) |
| Enumeration Date | 2009-09-24 |
| Last Update Date | 2023-08-04 |