| NPI | 1275848830 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARTIN A DETTMER President 1630-665-5550 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: IL 019.014036) |
| Enumeration Date | 2010-08-07 |
| Last Update Date | 2010-08-07 |