| NPI | 1205158524 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICHOLAS ANTHONY VIDEKA CEO 708-798-0444 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: IL 019018734) |
| Enumeration Date | 2010-03-01 |
| Last Update Date | 2010-03-01 |