| NPI | 1336477769 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DUANE HANSEN Sole Member 815-965-5555 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IL 019019603) |
| Enumeration Date | 2009-11-23 |
| Last Update Date | 2009-11-23 |