| NPI | 1033383567 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK L CANNON President 847-634-6166 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: IL 060.003411019.021533) |
| Enumeration Date | 2008-04-16 |
| Last Update Date | 2008-04-16 |