| NPI | 1588070148 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK B JACOB Owner 847-433-6636 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QS0112X Clinic/Center, Oral and Maxillofacial Surgery (Licence: IL 021.002059) |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental (Licence: IL 019.022948) |
| Enumeration Date | 2014-07-03 |
| Last Update Date | 2014-07-03 |