| NPI | 1043352354 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER ANN REYES Office Manager 847-882-3360 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: IL 019.021868) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IL 019.021872) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: IL 019.023646) | |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: IL 019.026464) | |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: IL 019.015237) | |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: IL 019.025711) | |
| Enumeration Date | 2007-02-13 |
| Last Update Date | 2018-06-27 |