| NPI | 1376869024 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WILLIAM CREVIER President 708-250-6175 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IL 019.021712) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036.074856) |
| Enumeration Date | 2010-04-19 |
| Last Update Date | 2010-04-19 |