| NPI | 1396875662 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRACY CARLSON HALL Office Manager 847-869-5417 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: IL 021-001971) |
| Enumeration Date | 2007-03-06 |
| Last Update Date | 2020-08-22 |