| NPI | 1154483451 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRIAN PAUL DEL CARLO Owner 630-969-4413 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IL 19025025) |
| Additional Taxonomies | 1223P0300X Dentist Periodontics |
| 1223S0112X Dentist Oral and Maxillofacial Surgery | |
| Enumeration Date | 2006-12-14 |
| Last Update Date | 2007-08-30 |