| NPI | 1871455832 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PRASANTH DOMMARAJU Director 630-247-7216 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Additional Taxonomies | 122300000X Dentist |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics | |
| Enumeration Date | 2025-11-28 |
| Last Update Date | 2025-11-28 |