| NPI | 1356788442 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | COREY J WALTHER Owner/Dentist 847-882-3683 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IL 019021603) |
| Enumeration Date | 2013-05-29 |
| Last Update Date | 2013-05-29 |