| NPI | 1952502221 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ERIC EDWARD KLEIN Owner 815-806-1451 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IL 019-025045) |
| Enumeration Date | 2007-05-31 |
| Last Update Date | 2020-08-22 |