| NPI | 1184736241 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GREGORY L. FAUTH President 630-896-2900 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: IL 211159) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2012-06-04 |