| NPI | 1407489446 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSEPH R CEISEL Owner 847-256-4270 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental |
| Additional Taxonomies | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment |
| Enumeration Date | 2020-02-18 |
| Last Update Date | 2020-02-18 |