| NPI | 1023161817 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RUDOLFO M VALENTE Secretary 312-266-7118 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: IL 060006963) |
| Enumeration Date | 2007-01-18 |
| Last Update Date | 2020-08-22 |