| NPI | 1902061344 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIMOTHY EMERSON SKIDMORE President 630-208-0051 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center Dental (Licence: IL 019025894) |
| Enumeration Date | 2008-07-24 |
| Last Update Date | 2008-07-24 |