| NPI | 1205095387 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HOLLY A. WALES Practice Practice Manager 847-869-1080 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: IL 060.001866021.001194) |
| Enumeration Date | 2008-06-04 |
| Last Update Date | 2025-05-09 |