| NPI | 1316110547 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EDISON ALBERT ISHAYA Dentist 773-235-0000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IL 019024678) |
| Enumeration Date | 2008-04-09 |
| Last Update Date | 2008-05-02 |