| NPI | 1295134112 |
|---|---|
| Doing Business As | NORTHSIDE DENTAL |
| Entity Type | Organization |
| Authorized Contact | BRENT E. AGRAN Owner 773-561-2237 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IL 019027610) |
| Enumeration Date | 2014-08-15 |
| Last Update Date | 2018-08-02 |