| NPI | 1821010703 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THOMAS JAMES VANBLADEL President 847-398-0326 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IL 19a13222) |
| Enumeration Date | 2006-07-23 |
| Last Update Date | 2020-08-22 |