| NPI | 1992928568 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRETT DONALD ANDERSON Owner 847-692-2303 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IL 019023301) |
| Enumeration Date | 2007-04-11 |
| Last Update Date | 2020-08-22 |