| NPI | 1114472297 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | REBECCA BARTLETT Office Manager 815-284-6807 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IL 019018857) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019019615) |
| Enumeration Date | 2016-08-18 |
| Last Update Date | 2016-08-18 |