| NPI | 1972616720 |
|---|---|
| Doing Business As | PROSPECT DENTAL |
| Entity Type | Organization |
| Authorized Contact | KATHY PAWLKSIENICA Owner 847-890-4444 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IL 019 026593) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019 026158) |
| Enumeration Date | 2006-08-16 |
| Last Update Date | 2020-08-22 |