| NPI | 1689892267 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ASHOK T KOTHARI Orthodontist 815-729-0002 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: IL 019019008) |
| Enumeration Date | 2007-04-21 |
| Last Update Date | 2020-08-22 |