| NPI | 1275770596 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MAZEN MANLA Presedent 312-451-4050 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MN D 11855) |
| Enumeration Date | 2009-01-08 |
| Last Update Date | 2009-01-08 |