| NPI | 1780763904 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HARRY KUNELIS Dentist 815-469-7000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IL 019026017) |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: IL 019012758) |
| Enumeration Date | 2006-11-06 |
| Last Update Date | 2020-08-22 |