| NPI | 1285070615 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIMOTHY BASHFORD President 847-470-0240 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Additional Taxonomies | 122300000X Dentist |
| 1223E0200X Dentist, Endodontics | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery | |
| Enumeration Date | 2013-05-13 |
| Last Update Date | 2014-02-28 |