| NPI | 1679212203 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MONIKA BZDAL VP Of Support Services 815-340-1046 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2022-06-01 |
| Last Update Date | 2022-06-01 |