| NPI | 1144604224 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMES L. DERRICO Owner 630-983-8700 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IL 019.019814) |
| Additional Taxonomies | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment |
| Enumeration Date | 2015-07-17 |
| Last Update Date | 2015-07-17 |