Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 19019417 | IL |
NPI | 1003981119 |
---|---|
Provider Name | Terry M Sandroff |
First Address | Arlington Hts, IL 60004 |
Second Address | Arlington Hts, IL 60004 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/11/2006 |
Last Update Date | 08/07/2007 |