| NPI | 1821139171 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIMBERLY KEATING Office Manager 847-982-0640 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0300X Dentist Periodontics |
| Additional Taxonomies | 1223P0300X Dentist Periodontics |
| Enumeration Date | 2007-02-09 |
| Last Update Date | 2020-08-22 |