| NPI | 1467607556 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUZANNA DJUKIC Business Manager 219-384-4031 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IL 019024315) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: IL 021002047) |
| Enumeration Date | 2008-11-18 |
| Last Update Date | 2008-11-18 |