| NPI | 1861578163 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GREGORY FRANK KUBIK President 815-455-7757 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: IL 021-001258) |
| Enumeration Date | 2006-10-29 |
| Last Update Date | 2020-08-22 |