| NPI | 1942472279 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | OFELIA POD Manager 815-444-8888 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IL 060009479) |
| Enumeration Date | 2008-03-26 |
| Last Update Date | 2008-03-26 |