| NPI | 1679977458 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PACITA MARIE PUMILIA Dentist 815-398-2410 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment (Licence: IL 019021788) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 319.010939) |
| Enumeration Date | 2014-10-22 |
| Last Update Date | 2018-01-22 |