| NPI | 1174883078 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID E BERTAGNA Dentist 773-736-1406 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: IL 019020864) |
| Enumeration Date | 2012-05-24 |
| Last Update Date | 2012-05-24 |