| NPI | 1003826116 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEVIN MCCOY President 773-286-5935 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: IL 021-001497) |
| Enumeration Date | 2006-08-09 |
| Last Update Date | 2020-08-22 |