| NPI | 1013075480 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | J. MICHAEL CVENGROS COO & Practice Administrator 708-922-1165 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: IL 060000064) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: IL 060000064) |
| Enumeration Date | 2006-12-05 |
| Last Update Date | 2014-10-17 |