| NPI | 1710411178 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIM STIRNEMAN Manager 847-854-7645 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IL 019020274) |
| 1223G0001X Dentist, General Practice (Licence: IL 19017265) | |
| 1223G0001X Dentist, General Practice (Licence: IL 19029584) | |
| Enumeration Date | 2017-04-12 |
| Last Update Date | 2017-04-12 |