| NPI | 1104302439 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRISTY WOLTER Insurance Manager 630-869-5857 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: IL 19017598) |
| Enumeration Date | 2018-07-19 |
| Last Update Date | 2018-07-19 |