| NPI | 1609136373 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SONAL C MEHTA Owner/President 815-725-0260 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IL 019027726) |
| Enumeration Date | 2012-05-29 |
| Last Update Date | 2017-03-15 |