| NPI | 1295379691 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | REINA SORIANO Credentialing 773-904-2984 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2019-10-30 |
| Last Update Date | 2020-01-21 |