| NPI | 1043489875 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALBERT L JACKSON Dentist /Owner 312-368-1600 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center Dental (Licence: IL 019011493) |
| Enumeration Date | 2008-02-26 |
| Last Update Date | 2008-02-26 |