| NPI | 1700207594 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN ALVAN GORDON Treasurer 630-878-0351 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IL 019020648) |
| Enumeration Date | 2013-12-20 |
| Last Update Date | 2013-12-23 |