| NPI | 1164795175 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMES M GORIL President 773-646-4664 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center Dental (Licence: IL 019-17193) |
| Enumeration Date | 2012-02-22 |
| Last Update Date | 2012-02-22 |