| NPI | 1972027878 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHARON HANNE Owner 618-972-8655 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IL 019.024344) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MO 015867) |
| 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment (Licence: IL 019.024344) | |
| Enumeration Date | 2017-08-01 |
| Last Update Date | 2022-07-21 |