| NPI | 1144685702 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN MICHAEL CONNESS Owner 815-434-1022 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IL 019018550) |
| Enumeration Date | 2015-12-28 |
| Last Update Date | 2016-01-26 |