| NPI | 1043615669 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LEE JOSEPH MOORE Dentist/Owner 773-779-8900 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IL 019014938) |
| Enumeration Date | 2014-10-24 |
| Last Update Date | 2014-10-24 |