| NPI | 1619242906 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SAMY SAMAAN Owner 815-744-4443 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IL 019026223) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IL 019028659) |
| Enumeration Date | 2012-03-20 |
| Last Update Date | 2012-03-20 |