| NPI | 1861837973 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESSIE KUNNEL President 847-675-5590 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223D0001X Dentist, Dental Public Health (Licence: IL 019024836) |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: IL 019024293) |
| Enumeration Date | 2013-05-02 |
| Last Update Date | 2013-05-02 |