| NPI | 1073634051 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMES WALTER MCGOUGH President 630-892-1515 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: IL 060004049) |
| Enumeration Date | 2007-04-03 |
| Last Update Date | 2020-08-22 |