| NPI | 1003951153 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HENRY J. BRATCHER President 815-725-4070 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: IL 019017417) |
| Enumeration Date | 2007-02-20 |
| Last Update Date | 2020-08-22 |