| NPI | 1962581736 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMES GLEN BROSNAN President 708-952-9185 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center Dental (Licence: IL 19A12667) |
| Enumeration Date | 2006-11-03 |
| Last Update Date | 2020-08-22 |