| NPI | 1043344492 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHEN P RUSSO Partner 847-675-7555 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: IL 019-026457) |
| Enumeration Date | 2007-03-16 |
| Last Update Date | 2020-08-22 |