| NPI | 1962653600 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RICHARD C PRENDERGAST President/Periodontist 847-491-1880 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: IL 021000596) |
| Enumeration Date | 2008-09-30 |
| Last Update Date | 2008-09-30 |