NPI | 1144404013 |
---|---|
Entity Type | Organization |
Authorized Contact | JAMES RUDOLPH CHAPKO Dentist 815-544-5144 |
Organization Subpart ? | No |
Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: IL 019019738) |
Enumeration Date | 2007-12-27 |
Last Update Date | 2012-06-18 |