| NPI | 1013068972 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARY ELIZABETH TIERNEY President 773-293-2700 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: IL 019023839) |
| Enumeration Date | 2007-01-16 |
| Last Update Date | 2020-08-22 |