| NPI | 1912259185 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMES FERRIS Dentist 815-625-6842 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IL 019018087) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| Enumeration Date | 2012-10-11 |
| Last Update Date | 2012-10-11 |