| NPI | 1114296712 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PRASAD GONAVARUM Owner 847-695-3368 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IL 019019439) |
| Enumeration Date | 2011-12-28 |
| Last Update Date | 2011-12-28 |