| NPI | 1770796005 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DENISE LYNN BODEN Office Manager 630-665-7474 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IL 019.024764) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019.018126) |
| Enumeration Date | 2007-05-07 |
| Last Update Date | 2008-06-26 |