| NPI | 1598056780 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THOMAS WEGNER President/Dentist 708-383-0330 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center Dental (Licence: IL 019019065) |
| Enumeration Date | 2011-04-22 |
| Last Update Date | 2011-04-22 |