| NPI | 1619312477 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSEPH FAVIA Owner/Dentist 847-398-0811 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IL 019023280) |
| Additional Taxonomies | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment |
| Enumeration Date | 2013-05-07 |
| Last Update Date | 2013-05-07 |