| NPI | 1548214034 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NANCY SMITH WALLACE President 847-662-6080 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IL 019021770) |
| Enumeration Date | 2006-05-20 |
| Last Update Date | 2020-08-22 |