| NPI | 1215345939 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK A KOLOZENSKI Dentist/Owner 815-201-1000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: IL 021001669) |
| Enumeration Date | 2014-07-25 |
| Last Update Date | 2014-07-25 |