| NPI | 1558549154 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GUS JOSEPH HUERTA Dentist Owner President 815-995-8484 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 32320) |
| Enumeration Date | 2008-02-06 |
| Last Update Date | 2008-02-06 |