| NPI | 1578674594 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENNETH HAROLD PETERSON Orthodontist 630-357-4060 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: IL 021000671) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2020-08-22 |