| NPI | 1306365234 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GEORGE MATHEW Dentist 847-414-3560 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: IL 019.027466) |
| Enumeration Date | 2017-09-12 |
| Last Update Date | 2017-09-12 |