| NPI | 1659442788 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEVIN MICHAEL BOEHM Owner 630-681-1280 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IL 019-023670) |
| Enumeration Date | 2006-11-12 |
| Last Update Date | 2020-08-22 |