| NPI | 1255705273 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JASON KORKUS Board Member 312-925-0042 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223D0001X Dentist, Dental Public Health (Licence: FL DN20850) |
| Enumeration Date | 2015-11-16 |
| Last Update Date | 2015-11-16 |