| NPI | 1326498130 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAUL S PETRUNGARO Owner 312-415-7481 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: IL 021001401) |
| Enumeration Date | 2016-06-13 |
| Last Update Date | 2017-01-24 |