NPI | 1972153070 |
---|---|
Entity Type | Organization |
Authorized Contact | TANYA L DESANTO Dentist/Owner 217-546-0412 |
Organization Subpart ? | Yes |
Primary Taxonomy | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment |
Enumeration Date | 2019-09-19 |
Last Update Date | 2019-10-21 |