| NPI | 1518416544 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID BLACKMAN Dentist 630-260-1700 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IL 19017755) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: IL 21001200) |
| Enumeration Date | 2016-10-03 |
| Last Update Date | 2016-10-03 |