| NPI | 1083995526 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ELIZABETH LEE Enrollment/Development Coord. 312-274-4526 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MI 2901020515) |
| Enumeration Date | 2011-08-29 |
| Last Update Date | 2011-08-29 |