ANDREW ADIPUTRA
Individual Provider (NPI-1)
Active
Dentist
Provider Information
- NPI Number
1205489671- Provider Type
- Individual Provider (NPI-1)
- Status
- Active
Contact & Location
- Address
- 314 W KIRBY AVE, CHAMPAIGN, IL, 618207208
- Phone
- (217) 398-9898
Specialties & Taxonomies
Dentist
Primary License: IL #019032270