| NPI | 1376651679 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFFREY JAMES JOHNSON Pediatric Dentist Owner President 815-398-2323 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: IL 019) |
| Enumeration Date | 2006-08-27 |
| Last Update Date | 2020-08-22 |