Individual
ANDREW ADIPUTRA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
314 W KIRBY AVE, CHAMPAIGN, IL 61820-7208
(217) 398-9898
Mailing address
314 W KIRBY AVE, CHAMPAIGN, IL 61820-7208
(217) 398-9898
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
019032270
IL
Other
Enumeration date
07/24/2019
Last updated
07/24/2019
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