| NPI | 1497809222 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIRK KOLLMANN President 773-545-0007 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IL 019.021691) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: IL 021.001797) |
| Enumeration Date | 2007-01-22 |
| Last Update Date | 2020-08-22 |