| NPI | 1184712952 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CANDICE LEIGH GIBBONS President 815-485-2536 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IL 019.024459) |
| Enumeration Date | 2006-10-10 |
| Last Update Date | 2008-08-12 |