| NPI | 1205984440 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEVIN THOMAS KING Manager 773-775-3663 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: IL 19A16281) |
| Enumeration Date | 2007-01-06 |
| Last Update Date | 2020-08-22 |