| NPI | 1982878708 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SARA R RAUEN DARDIS Pediatric Dentist 309-663-7339 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: IL 019025801) |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental (Licence: IL 019021074) |
| Enumeration Date | 2008-04-14 |
| Last Update Date | 2008-04-14 |