| NPI | 1821240169 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRANDON FARLEY BECKER CEO/Owner 847-841-6665 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Additional Taxonomies | 124Q00000X Dental Hygienist |
| 207N00000X Dermatology | |
| Enumeration Date | 2008-10-17 |
| Last Update Date | 2008-10-17 |