| NPI | 1235209727 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSE MARISCAL Owner 773-929-4140 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: IL 019020112) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: IL 019027020) |
| Enumeration Date | 2006-11-09 |
| Last Update Date | 2018-02-21 |