| NPI | 1801963558 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEAN MOON PARK President 630-897-1300 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IL 019020375) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IL 019022694) |
| 1223G0001X Dentist, General Practice (Licence: IL 019024704) | |
| Enumeration Date | 2006-11-29 |
| Last Update Date | 2008-04-23 |