| NPI | 1073379160 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PETER DURBIN Owner 847-824-0154 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2024-02-26 |
| Last Update Date | 2024-02-26 |