| NPI | 1023219326 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THEODORE EDMUND BRASKY President 708-349-1515 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IL 060-000828) |
| Enumeration Date | 2007-05-31 |
| Last Update Date | 2008-07-31 |