| NPI | 1659691467 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNY KWON BARUCH Dentist 815-477-2369 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: IL 019028247) |
| Enumeration Date | 2010-06-03 |
| Last Update Date | 2012-03-02 |