| NPI | 1962526277 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRENT DEE BANKHEAD Doctor 618-281-3399 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: MO 015876) |
| Enumeration Date | 2007-03-19 |
| Last Update Date | 2020-08-22 |