| NPI | 1255595310 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DONNA RYAN Office Manager 630-893-4530 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: IL 019015102) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: IL 019015979) |
| Enumeration Date | 2008-07-17 |
| Last Update Date | 2012-04-25 |