| NPI | 1992197883 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENDRA WALKER Credentialing COO Rdinator 217-540-8312 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: OH 30024311) |
| Enumeration Date | 2015-03-02 |
| Last Update Date | 2015-03-04 |