| NPI | 1982822912 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN MICHAEL SISTO President 847-696-4848 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0106X Dentist, Oral and Maxillofacial Pathology (Licence: IL 019 016656) |
| Enumeration Date | 2007-04-23 |
| Last Update Date | 2020-08-22 |