| NPI | 1710091673 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALEXANDER QUEZADA Doctor 847-729-2233 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice |
| Additional Taxonomies | 1223G0001X Dentist General Practice |
| 1223G0001X Dentist General Practice | |
| Enumeration Date | 2006-08-18 |
| Last Update Date | 2020-08-22 |