| NPI | 1184796948 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RANDALL J. HODOVAL President 815-436-4900 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IL 1917621) |
| Enumeration Date | 2006-11-15 |
| Last Update Date | 2010-05-05 |