| NPI | 1205911120 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GREGORY WAYNE JACKSON President 773-767-0849 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: IL 060-002976) |
| Enumeration Date | 2006-10-26 |
| Last Update Date | 2020-08-22 |