| NPI | 1679595243 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMES JOSEPH MALINOWSKI Treasurer 815-725-1605 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IL 060-004320) |
| Enumeration Date | 2006-07-24 |
| Last Update Date | 2020-08-22 |