| NPI | 1407211170 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TODD STERN Owner 815-398-3879 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: IL 019024307) |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental (Licence: IL 019030473) |
| 261QD0000X Clinic/Center, Dental (Licence: IL 019021620) | |
| Enumeration Date | 2015-12-23 |
| Last Update Date | 2017-06-19 |