| NPI | 1063702512 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIMOTHY PATRICK BASHFORD Owner 847-256-9507 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: IL 019017695) |
| Enumeration Date | 2011-04-18 |
| Last Update Date | 2011-04-18 |