| NPI | 1326118340 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TONY T. ATHANS Owner 847-498-3333 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IL 060-007385) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019.023594) |
| Enumeration Date | 2006-11-08 |
| Last Update Date | 2020-08-22 |