| NPI | 1235267469 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHEFFIELD S HYDE Treasurer 847-358-3939 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0300X Dentist Periodontics (Licence: IL 060000422) |
| Enumeration Date | 2007-03-01 |
| Last Update Date | 2022-09-20 |