| NPI | 1275145534 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIMOTHY P BASHFORD Owner 847-999-8004 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment |
| Additional Taxonomies | 122300000X Dentist |
| Enumeration Date | 2020-08-18 |
| Last Update Date | 2024-09-20 |