| NPI | 1477736981 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK I LUNDELL Owner 847-446-0880 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IL 019018227) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019027336) |
| Enumeration Date | 2007-12-07 |
| Last Update Date | 2007-12-07 |