| NPI | 1245822162 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | INEKE CATHERINE BASILE Office Manager 815-933-0990 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery |
| Enumeration Date | 2021-02-11 |
| Last Update Date | 2021-02-11 |