| NPI | 1144654468 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | OSMAR RODRIGUEZ President 773-879-3400 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: IL 019018384) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019025096) |
| Enumeration Date | 2013-08-22 |
| Last Update Date | 2013-08-22 |