| NPI | 1316131626 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VLAD FERDKOFF Owner 815-439-2400 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IL 019024754) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: KS 019026078) |
| 1223G0001X Dentist, General Practice (Licence: MA 019026102) | |
| 1223G0001X Dentist, General Practice (Licence: NY 019025898) | |
| 1223G0001X Dentist, General Practice (Licence: IL 019027030) | |
| 1223P0300X Dentist, Periodontics (Licence: IL 021001883) | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: IL 021002191) | |
| Enumeration Date | 2007-08-29 |
| Last Update Date | 2007-08-29 |