| NPI | 1922272939 |
|---|---|
| Former Legal Business Name | CHARLES H. EKSTROM D.D.S., P.C. |
| Entity Type | Organization |
| Authorized Contact | CYNTHIA MARIE SACHS President 815-963-1731 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IL 019-022280) |
| Enumeration Date | 2008-04-22 |
| Last Update Date | 2008-04-22 |