| NPI | 1891825527 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAULL C GOSSETT Owner (President) 708-354-0835 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IL 019018250) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019027081) |
| Enumeration Date | 2007-03-06 |
| Last Update Date | 2008-09-02 |