| NPI | 1164091864 |
|---|---|
| Doing Business As | EDISON PARK DENTAL |
| Entity Type | Organization |
| Authorized Contact | THOMAS W. PISSIOS President 773-792-3200 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2021-06-18 |
| Last Update Date | 2021-06-18 |