| NPI | 1265588420 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THEODORE LEE MOSS President 847-295-7581 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: IL 1915769) |
| Enumeration Date | 2007-01-28 |
| Last Update Date | 2020-08-22 |