| NPI | 1366599748 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NEIL BRUCE HAGEN Owner 312-926-2929 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: IL 21-001074) |
| Enumeration Date | 2007-01-05 |
| Last Update Date | 2009-05-11 |