| NPI | 1043767916 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RICHARD B DIVERDE Owner/General Dentist 312-263-7822 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IL 019019078) |
| Enumeration Date | 2016-09-08 |
| Last Update Date | 2016-09-08 |