| NPI | 1962415976 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEVEN CLAY SIMMONS President/Dentist 217-546-6262 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IL 19A15243) |
| Enumeration Date | 2006-08-14 |
| Last Update Date | 2020-08-22 |