| NPI | 1578642369 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARYANN E ANDREW Office Manager 847-677-2808 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IL 019021156) |
| Enumeration Date | 2006-11-03 |
| Last Update Date | 2016-04-08 |