| NPI | 1548366081 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFFREY T BOLAND Owner 630-279-5577 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: IL 021001836) |
| Enumeration Date | 2006-09-15 |
| Last Update Date | 2020-08-22 |