| NPI | 1790432219 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MOLLY WALSH Practice Operations Director 630-627-3930 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2022-03-04 |
| Last Update Date | 2022-03-04 |