| NPI | 1952452047 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN E. COSTELLO Dentist/Owner 847-259-1111 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: IL 19A12900) |
| Enumeration Date | 2007-01-15 |
| Last Update Date | 2015-09-09 |