| NPI | 1306988092 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHEN C ROEHM President 309-691-9665 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: IL 021001043) |
| Enumeration Date | 2007-02-12 |
| Last Update Date | 2020-08-22 |