NPI | 1972377174 |
---|---|
Entity Type | Organization |
Authorized Contact | GRANT STEVEN SEVERS President 217-919-5008 |
Organization Subpart ? | No |
Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
Enumeration Date | 2023-11-08 |
Last Update Date | 2023-11-08 |