| NPI | 1851566400 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIMBERLY DAWN SHEPPARD President/Periodontist 847-885-1664 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0300X Dentist Periodontics (Licence: IL 019026359) |
| Enumeration Date | 2008-04-24 |
| Last Update Date | 2008-04-24 |