| NPI | 1215305461 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIMOTHY DOUGLAS STIRNEMAN President 224-232-9212 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IL 019022088) |
| Additional Taxonomies | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment |
| Enumeration Date | 2015-09-04 |
| Last Update Date | 2015-09-10 |