| NPI | 1568675395 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LYNN ANN OLSON Office Manager 847-392-3122 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IL 019021159) |
| Enumeration Date | 2007-05-08 |
| Last Update Date | 2020-08-22 |