| NPI | 1831427335 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN M. ROSE Orthodontist 815-802-1217 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2009-11-23 |
| Last Update Date | 2009-11-23 |