| NPI | 1275855306 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBERT C POULSOM Owner/President 630-852-1020 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: IL 21.000877) |
| Enumeration Date | 2010-02-16 |
| Last Update Date | 2010-02-16 |