| NPI | 1811015084 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MATTHEW E GAUTHIER Oral Surgeon 847-392-6220 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IL 019016047) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019019734) |
| 122300000X Dentist (Licence: IL 019015876) | |
| 122300000X Dentist (Licence: IL 019025795) | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: IL 021001087) | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: IL 021001407) | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: IL 021001157) | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: IL 021002123) | |
| Enumeration Date | 2007-03-27 |
| Last Update Date | 2011-10-13 |