| NPI | 1205841996 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANDREW T WEISS President 773-528-2205 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: IL 021000831) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019020453) |
| 122300000X Dentist (Licence: IL 019014591) | |
| 122300000X Dentist (Licence: IL 019017259) | |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: IL 021000499) | |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: IL 019028564) | |
| Enumeration Date | 2006-07-30 |
| Last Update Date | 2011-12-29 |