NPI | 1972756286 |
---|---|
Doing Business As | INDIAN LAKE FAMILY DENTAL |
Entity Type | Organization |
Authorized Contact | AMY KROEGER Ins COO Rdinator 217-540-5100 |
Organization Subpart ? | Yes |
Primary Taxonomy | 1223G0001X Dentist General Practice |
Enumeration Date | 2008-10-30 |
Last Update Date | 2008-10-30 |