| NPI | 1316152176 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALAN ANDREW DALESSANDRO Owner 847-884-0125 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0300X Dentist Periodontics (Licence: IL 19016716) |
| Enumeration Date | 2007-05-14 |
| Last Update Date | 2020-08-22 |