| NPI | 1780758193 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FREDERICK P WALDSCHMIDT President Secretary Treasurer 815-932-5221 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IL 019019355) |
| Enumeration Date | 2006-11-17 |
| Last Update Date | 2015-04-21 |