| NPI | 1104648468 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VAIBHAV JAGAD Manager 815-995-2852 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2024-10-28 |
| Last Update Date | 2024-11-20 |