| NPI | 1750431904 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIMOTHY M LEE President 847-584-4494 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Additional Taxonomies | 122300000X Dentist |
| Enumeration Date | 2007-01-11 |
| Last Update Date | 2020-08-22 |