| NPI | 1306172804 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GADIA PEABODY General Dentist 708-460-7440 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IL 019-026130) |
| Enumeration Date | 2009-10-19 |
| Last Update Date | 2009-10-19 |