| NPI | 1124549399 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHEFALI PATEL Owner 815-577-0900 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IL 019025824) |
| Enumeration Date | 2017-06-28 |
| Last Update Date | 2022-07-21 |