| NPI | 1174740393 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEDE LUSH Manager 773-327-3131 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics |
| 1223P0300X Dentist, Periodontics | |
| Enumeration Date | 2007-04-19 |
| Last Update Date | 2025-09-11 |