| NPI | 1679877195 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIMOTHY L STRAKA Member 847-360-8450 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IL 019018122) |
| Enumeration Date | 2010-12-23 |
| Last Update Date | 2010-12-23 |