| NPI | 1720136989 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TARA MOUSTIS President 815-464-8433 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IL 019-024605) |
| Enumeration Date | 2007-01-06 |
| Last Update Date | 2020-08-22 |