| NPI | 1225472749 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA HOPE GRANT Doctor/Owner 708-700-3030 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: IL 021001652) |
| Enumeration Date | 2013-04-26 |
| Last Update Date | 2013-04-26 |