| NPI | 1366505570 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENNETH WILLIAM BUELTMANN President 847-724-6343 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: IL 21-S753) |
| Enumeration Date | 2006-12-18 |
| Last Update Date | 2020-08-22 |