| NPI | 1104047091 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GARY GEORGE WEGMANN President 312-551-0500 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IL 019020724) |
| Enumeration Date | 2007-05-01 |
| Last Update Date | 2020-08-22 |