| NPI | 1780608349 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VICTOR RICARDO GONZALEZ-JIMENEZ President 630-898-3610 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IL 019-018457) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: IL 019-018457) | |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: IL 021-001246) | |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2015-02-03 |