| NPI | 1649286287 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENNETH HOWARD PESKIN President/Owner Oral Surgeon 847-676-4590 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2020-08-22 |