| NPI | 1114298155 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RICHARD NORMAN FACKO President 708-280-9234 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: IL 019.028264) |
| Enumeration Date | 2012-01-23 |
| Last Update Date | 2012-01-23 |