| NPI | 1962837047 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSHUA FOXSON Owner 630-708-6637 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QS0112X Clinic/Center Oral and Maxillofacial Surgery (Licence: IL 021002503) |
| Additional Taxonomies | 261QD0000X Clinic/Center Dental (Licence: IL 019029110) |
| Enumeration Date | 2013-09-09 |
| Last Update Date | 2017-05-04 |