| NPI | 1750747978 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JASMINE N HARVALA Office Manager 815-439-1270 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IL 019027616) |
| Enumeration Date | 2016-01-04 |
| Last Update Date | 2016-01-04 |