| NPI | 1306483433 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIMIKA WESLEY Office Manager 708-865-0200 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2019-12-09 |
| Last Update Date | 2025-01-13 |