| NPI | 1164829032 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROGER NOUNEH Managing Member 312-337-3300 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IL 019025485) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019029429) |
| 122300000X Dentist (Licence: IL 019029061) | |
| 122300000X Dentist (Licence: IL 019029936) | |
| 122300000X Dentist (Licence: IL 019029031) | |
| 1223P0300X Dentist, Periodontics (Licence: IL 021001990) | |
| Enumeration Date | 2014-11-20 |
| Last Update Date | 2014-11-20 |