| NPI | 1013336445 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PETE A GALLOS Dentist 815-254-1375 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IL 019025501) |
| Enumeration Date | 2014-04-14 |
| Last Update Date | 2014-04-14 |