| NPI | 1699839266 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFFREY A. WELLER President 312-654-0606 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IL 19020147) |
| Enumeration Date | 2006-12-20 |
| Last Update Date | 2020-08-22 |