| NPI | 1861565871 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAUL A BRUGGEMAN Owner 815-455-3123 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IL 19A14532) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019025380) |
| Enumeration Date | 2006-11-16 |
| Last Update Date | 2020-08-22 |