| NPI | 1114398831 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DOMINIK B. DUBRAVEC Owner 815-464-3001 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: IL 019021633) |
| Enumeration Date | 2015-10-08 |
| Last Update Date | 2015-10-08 |