| NPI | 1427148642 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GREGORY NICHOLAS STEVENS President 630-725-3333 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QS0112X Clinic/Center, Oral and Maxillofacial Surgery (Licence: IL 019016917//021001238) |
| Enumeration Date | 2006-10-16 |
| Last Update Date | 2020-08-22 |