| NPI | 1972894251 |
|---|---|
| Doing Business As | EASTSIDE GENERAL DENTISTRY |
| Entity Type | Organization |
| Authorized Contact | KAM SHICK Insurance Coordinator 217-540-5141 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2011-04-21 |
| Last Update Date | 2011-04-21 |