| NPI | 1992804611 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEVEN WADE LONG President/Owner 630-443-5000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: IL 19015884) |
| Enumeration Date | 2006-09-21 |
| Last Update Date | 2020-08-22 |