| NPI | 1750494142 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SCOTT P. FOGEL Owner 815-933-5173 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IL 019026391) |
| Enumeration Date | 2006-08-17 |
| Last Update Date | 2012-11-26 |