| NPI | 1265962674 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PHILLIP PALELLA Owner 773-489-5700 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental |
| 305R00000X Preferred Provider Organization | |
| Enumeration Date | 2017-06-18 |
| Last Update Date | 2017-06-18 |