| NPI | 1255879946 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RICHARD MADDALOZZO Member 847-934-4280 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: IL 019021223) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: IL 019021223) |
| 1223P0300X Dentist Periodontics (Licence: IL 021001510) | |
| Enumeration Date | 2017-02-02 |
| Last Update Date | 2017-02-02 |