Individual
AUTUMN TATMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
201 W KENYON RD, CHAMPAIGN, IL 61820-7892
(217) 531-4279
Mailing address
201 W KENYON RD, CHAMPAIGN, IL 61820-7892
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
020.015266
IL
Other
Enumeration date
07/21/2022
Last updated
07/21/2022
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