NPI | 1942611207 |
---|---|
Entity Type | Organization |
Authorized Contact | ANDREW ANTHONY ROECHNER President 815-725-8075 |
Organization Subpart ? | No |
Primary Taxonomy | 261QD0000X Clinic/Center Dental (Licence: IL 019-022413) |
Enumeration Date | 2014-05-08 |
Last Update Date | 2014-05-08 |