| NPI | 1821549163 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUSAN EDUKUTHARAYIL General Dentist 847-581-1418 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: IL 019024490) |
| Enumeration Date | 2016-10-21 |
| Last Update Date | 2016-10-21 |