| NPI | 1245624139 |
|---|---|
| Doing Business As | ST. JUDE THADDEOUS DENTAL GROUP |
| Entity Type | Organization |
| Authorized Contact | JAIME RICK MARQUEZ Presidente 773-677-3797 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IL 019030099) |
| Enumeration Date | 2015-03-27 |
| Last Update Date | 2015-03-27 |