| NPI | 1457589715 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN A GORDON Officer 630-878-0351 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IL 019020648) |
| Additional Taxonomies | 292200000X Dental Laboratory |
| Enumeration Date | 2009-06-25 |
| Last Update Date | 2009-06-25 |