NPI | 1982738092 |
---|---|
Entity Type | Organization |
Authorized Contact | RONALD DALE RIGGINS President 309-797-2579 |
Organization Subpart ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IL 019025287) |
Enumeration Date | 2007-03-14 |
Last Update Date | 2020-08-22 |