| NPI | 1104331255 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MONIKA BZDAL Manager 773-801-7171 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2017-12-12 |
| Last Update Date | 2019-12-12 |