| NPI | 1457694853 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LONN EDWARD BRANDER Dentist/ Owner 815-756-2295 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IL 019-022322) |
| Additional Taxonomies | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment |
| Enumeration Date | 2013-04-03 |
| Last Update Date | 2014-04-02 |