| NPI | 1730388091 |
|---|---|
| Other Name | ORAL SURGERY OF THE GLEN |
| Entity Type | Organization |
| Authorized Contact | JULIE A LAVERDIERE BECK President/Owner 847-998-9992 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QS0112X Clinic/Center, Oral and Maxillofacial Surgery (Licence: IL 019022323) |
| Enumeration Date | 2007-07-16 |
| Last Update Date | 2007-08-03 |