| NPI | 1225108665 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RUSSELL J BAK Owner 630-759-4191 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IL 19-024912) |
| Enumeration Date | 2006-11-09 |
| Last Update Date | 2019-04-26 |