| NPI | 1497260152 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRISTY WOLTER Insurance Manager 630-339-3172 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: IL 019015666) |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental (Licence: IL 019018403) |
| Enumeration Date | 2017-12-04 |
| Last Update Date | 2017-12-04 |