| NPI | 1154481182 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HOWARD L BLIVAISS President 773-509-1234 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: IL 019017905) |
| Enumeration Date | 2006-12-11 |
| Last Update Date | 2020-08-22 |