| NPI | 1104285972 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RICHARD F. CALLAHAN Owner/President 815-939-2585 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2016-02-22 |
| Last Update Date | 2016-02-22 |