Individual
DAISY E CORNELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
301 TAMARACK LN, SHILOH, IL 62269-2993
(618) 632-5566
Mailing address
11043 WIDICUS RD, LEBANON, IL 62254-1157
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
019033724
IL
Other
Enumeration date
06/17/2022
Last updated
06/17/2022
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