| NPI | 1053665380 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SAM PHILIP CALABRESE Administrator 847-847-7736 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: IL 021.002483) |
| Enumeration Date | 2012-11-08 |
| Last Update Date | 2012-11-08 |