| NPI | 1215166327 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMY R MARTIN Owner 773-871-4964 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IL 019026201) |
| Enumeration Date | 2009-07-09 |
| Last Update Date | 2009-07-09 |