| NPI | 1174837025 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEITH W JAESCHKE Owner 815-942-0182 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IL 019.016384) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019.020128) |
| 122300000X Dentist (Licence: IL 019.016659) | |
| Enumeration Date | 2010-08-03 |
| Last Update Date | 2010-08-03 |