| NPI | 1003049537 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DARYL ASHBECK Orthodontist 815-363-8474 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: IL 019024635) |
| Enumeration Date | 2009-09-01 |
| Last Update Date | 2009-09-01 |