| NPI | 1760479778 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PETER A LO DESTRO Dentist 630-898-3100 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IL 319009004) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019019618) |
| Enumeration Date | 2005-10-04 |
| Last Update Date | 2020-08-22 |