| NPI | 1215000229 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL WARNE MATHEWSON President 815-284-2749 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: IL 019-017139) |
| Enumeration Date | 2006-11-16 |
| Last Update Date | 2015-05-12 |