| NPI | 1235406612 |
|---|---|
| Doing Business As | FOREST EDGE DENTAL |
| Entity Type | Organization |
| Authorized Contact | LARS ALAN JOHNSON Owner Dentist 312-388-3289 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IL 019026401) |
| Enumeration Date | 2011-11-29 |
| Last Update Date | 2011-11-29 |