| NPI | 1962822387 |
|---|---|
| Doing Business As | MYDENTIST-MIDTOWN ENDO |
| Entity Type | Organization |
| Authorized Contact | KENDRA WALKER Credentialing Coordinator 217-540-8312 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics |
| Enumeration Date | 2014-04-24 |
| Last Update Date | 2014-04-24 |