| NPI | 1114022191 |
|---|---|
| Former Legal Business Name | NONE |
| Entity Type | Organization |
| Authorized Contact | JUAN G MESA Doctor Dentist 773-267-9777 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IL 019025977) |
| Enumeration Date | 2006-09-14 |
| Last Update Date | 2008-02-28 |