| NPI | 1144579905 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN MINALT Member 630-671-0700 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IL 019021250) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019029179) |
| Enumeration Date | 2012-09-07 |
| Last Update Date | 2012-09-07 |