| NPI | 1417128489 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RICHARD RANDY MIKOS Owner/President 847-679-5558 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: IL 019018116) |
| Enumeration Date | 2008-03-18 |
| Last Update Date | 2008-03-18 |