| NPI | 1689737868 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEVEN PAUL THEODOSIS President Dentist 847-253-5800 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IL 019022523) |
| Enumeration Date | 2006-12-18 |
| Last Update Date | 2020-08-22 |