| NPI | 1225172323 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CARMEN IRIS GONZALEZ Office Manager 815-436-3377 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: IL 019025441) |
| Enumeration Date | 2007-02-20 |
| Last Update Date | 2008-06-20 |