| NPI | 1356897433 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RICK LEPPO Owner 618-281-6161 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment (Licence: IL 019027680) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019027680) |
| Enumeration Date | 2016-08-29 |
| Last Update Date | 2016-08-29 |