| NPI | 1144347303 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACQUELINE G ROSEN Orthodonist 847-215-9971 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2007-03-23 |
| Last Update Date | 2020-08-22 |