| NPI | 1295978104 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARY MILLER Office Manager 847-640-0778 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: IL 019016834) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IL 019022514) |
| 1223G0001X Dentist, General Practice (Licence: IL 019016362) | |
| 1223P0300X Dentist, Periodontics (Licence: IL 019022485) | |
| Enumeration Date | 2009-04-08 |
| Last Update Date | 2009-04-08 |