| NPI | 1578009577 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRYAN R BLAZER President/Owner 847-742-6717 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: IL 019.028688) |
| Enumeration Date | 2017-01-13 |
| Last Update Date | 2017-01-13 |