| NPI | 1285707307 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BETH M NELSON President 773-625-6838 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IL 060-007349) |
| Enumeration Date | 2006-11-16 |
| Last Update Date | 2020-08-22 |