| NPI | 1811379142 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHEA MCCUE Oral Surgeon/Owner 815-399-1234 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QS0112X Clinic/Center Oral and Maxillofacial Surgery (Licence: WI 019030148) |
| Enumeration Date | 2015-06-23 |
| Last Update Date | 2015-06-23 |