| NPI | 1053579219 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN HENRY KELSEY Preseident 847-831-1100 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: IL 060006833) |
| Enumeration Date | 2008-05-23 |
| Last Update Date | 2008-05-23 |