| NPI | 1235342064 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL MAZUKELLI President 847-823-4045 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IL 019-025508) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IL 019-025508) |
| Enumeration Date | 2007-05-08 |
| Last Update Date | 2020-08-22 |