| NPI | 1578680625 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBERT DERELL DURR President Dentist 708-747-4294 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IL 019025548) |
| Enumeration Date | 2007-03-23 |
| Last Update Date | 2020-08-22 |