| NPI | 1679790828 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACQUELINE G ROSEN Owner 847-432-1614 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: IL 021-001225) |
| Enumeration Date | 2007-04-19 |
| Last Update Date | 2013-03-15 |