| NPI | 1912283730 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK B JACOB Owner 847-433-6636 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: IL 021002059) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: IL 019022948) |
| Enumeration Date | 2011-10-25 |
| Last Update Date | 2011-10-25 |