| NPI | 1225781214 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER LYNN GEISELHOFER Executive Director 708-650-6229 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223D0001X Dentist, Dental Public Health |
| Additional Taxonomies | 122300000X Dentist |
| 1223G0001X Dentist, General Practice | |
| 124Q00000X Dental Hygienist | |
| Enumeration Date | 2022-01-31 |
| Last Update Date | 2022-02-02 |