| NPI | 1538180617 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL R. HESTERBERG President 618-233-8080 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: IL 021-001364) |
| Enumeration Date | 2006-07-22 |
| Last Update Date | 2014-11-24 |