| NPI | 1326725813 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRITTNEY ANN JASEK Member / General Dentist 224-234-9304 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2023-06-28 |
| Last Update Date | 2023-06-28 |