| NPI | 1194895219 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEVEN MARK SIERASKI Member LLC 309-663-9521 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: IL 021001214) |
| Enumeration Date | 2006-11-08 |
| Last Update Date | 2020-08-22 |