| NPI | 1104245950 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TINA GRANDINETTI Office Manager 312-217-3333 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IL 019024774) |
| Enumeration Date | 2014-04-09 |
| Last Update Date | 2014-04-09 |