| NPI | 1144493685 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GARY OLSON President 773-488-5300 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IL 019016444) |
| Enumeration Date | 2008-04-04 |
| Last Update Date | 2008-04-04 |