| NPI | 1477801298 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL DAVID JOHNSON President 847-741-6217 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: IL 019.020007) |
| Enumeration Date | 2012-08-28 |
| Last Update Date | 2012-08-28 |