| NPI | 1124490875 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HOWARD LAWRENCE CRYSTAL President 773-370-6307 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: IL 019016617) |
| Enumeration Date | 2015-10-21 |
| Last Update Date | 2015-10-21 |