| NPI | 1306970397 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RONALD L ELDRIDGE Secretary Treasurer 708-206-1277 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IL 019018962) |
| Enumeration Date | 2007-03-14 |
| Last Update Date | 2014-11-20 |