| NPI | 1114350907 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HENRY EDWARD VALLELY Owner 847-392-4422 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IL 019.015568) |
| Enumeration Date | 2013-08-15 |
| Last Update Date | 2013-08-15 |