| NPI | 1003142100 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KARINA LYON GAVRILOV Owner 847-465-0800 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: IL 0019-024691) |
| Enumeration Date | 2009-10-23 |
| Last Update Date | 2009-10-23 |