| NPI | 1972723138 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | REGINA MARIE MCKENNA Office Administrator 847-524-3054 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IL 019.022793) |
| Enumeration Date | 2007-04-27 |
| Last Update Date | 2014-02-19 |