| NPI | 1093232951 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBERT C. BOSACK Owner/Oral Surgeon 708-460-9100 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: IL 021.001152) |
| Enumeration Date | 2017-08-23 |
| Last Update Date | 2022-07-21 |