| NPI | 1932585528 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLEN BOSMA President 815-758-5045 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: IL 019029540) |
| Enumeration Date | 2015-08-05 |
| Last Update Date | 2015-08-05 |