| NPI | 1194206052 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER ANN REYES Office Manager 847-882-3360 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: IL 021001554) |
| Enumeration Date | 2018-08-28 |
| Last Update Date | 2018-08-28 |