| NPI | 1992136345 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER A KENNEDY Dentist 217-235-0556 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: IL 019024517) |
| Enumeration Date | 2013-12-11 |
| Last Update Date | 2013-12-11 |