| NPI | 1417152059 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EDWARD J PAVLIK President 815-464-6465 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2007-06-15 |
| Last Update Date | 2007-07-13 |