| NPI | 1235201344 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK BENAVIDES Owner 815-434-0152 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IL 0019-20337) |
| Enumeration Date | 2006-11-14 |
| Last Update Date | 2013-12-17 |