| NPI | 1073991162 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALEXANDER REZNIKOV Owner/Dentist 847-877-3570 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IL 019029473) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics | |
| Enumeration Date | 2015-05-11 |
| Last Update Date | 2015-05-11 |