| NPI | 1285144154 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRISTINA DRAGSTREM Owner 708-246-4000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: IL 248001868) |
| Enumeration Date | 2017-10-05 |
| Last Update Date | 2018-03-17 |