NPI | 1962150458 |
---|---|
Entity Type | Organization |
Authorized Contact | CELIA HAYES Credentialing COO Rdinator 217-540-2100 |
Organization Subpart ? | Yes |
Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics |
Enumeration Date | 2022-03-14 |
Last Update Date | 2022-03-14 |