Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 019-016479 | IL |
NPI | 1003069055 |
---|---|
Provider Name | Dr. Elliott M. Garber |
First Address | Waukegan, IL 60085-6165 |
Second Address | Waukegan, IL 60085-6165 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/11/2008 |
Last Update Date | 03/11/2008 |