| NPI | 1669865135 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENNETH R. PICKETT President/Business Owner 630-527-0544 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IL 019.017904) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019.017904) |
| 122300000X Dentist (Licence: IL 019.029826) | |
| 1223G0001X Dentist, General Practice (Licence: IL 019.029826) | |
| 1223P0300X Dentist, Periodontics (Licence: IL 021.001252) | |
| Enumeration Date | 2015-03-09 |
| Last Update Date | 2015-03-09 |