| NPI | 1790998748 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JONATHAN VILLANUEVA Manager 630-355-9010 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: IL 019-022779) |
| Additional Taxonomies | 1223P0300X Dentist Periodontics (Licence: IL 021-002028) |
| 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: IL 021-001200) | |
| 1223G0001X Dentist General Practice (Licence: IL 019-025099) | |
| Enumeration Date | 2007-05-07 |
| Last Update Date | 2013-06-19 |