| NPI | 1205117041 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PETER STATHAKIS CFO 312-274-0308 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MI 2901020515) |
| Enumeration Date | 2011-09-07 |
| Last Update Date | 2015-09-17 |