| NPI | 1154578698 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WALTER BERGE BUSSE President 708-331-2322 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: IL 019014809) |
| Enumeration Date | 2008-08-27 |
| Last Update Date | 2008-08-27 |