| NPI | 1407208887 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBERTA ANNE WRIGHT Prosthodontist 815-603-3804 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0700X Dentist Prosthodontics (Licence: MA DN1857241) |
| Enumeration Date | 2016-07-08 |
| Last Update Date | 2016-07-08 |