| NPI | 1194436634 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHOUVIK PONNUSAMY Owner 630-267-1199 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics |
| 1223P0300X Dentist, Periodontics | |
| Enumeration Date | 2022-12-06 |
| Last Update Date | 2022-12-06 |