| NPI | 1255906244 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SASAN MOLAVI President / Sole Member 630-381-8281 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Additional Taxonomies | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2021-05-23 |
| Last Update Date | 2021-06-16 |