| NPI | 1376605428 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GINGER ANN CHRISTIAN President 815-729-0661 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IL 019023930) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019018859) |
| 122300000X Dentist (Licence: IL 019023056) | |
| Enumeration Date | 2006-12-15 |
| Last Update Date | 2020-08-22 |