| NPI | 1639322746 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRACY GAMM Officer Manager 815-625-2112 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: IL 021-000885) |
| Enumeration Date | 2008-11-03 |
| Last Update Date | 2008-11-03 |