NPI | 1710109145 |
---|---|
Entity Type | Organization |
Authorized Contact | DONALD J PROVENZALE Partner 630-969-7711 |
Organization Subpart ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IL 19021170) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IL 19A12314) |
Enumeration Date | 2007-05-03 |
Last Update Date | 2020-08-22 |