| NPI | 1336219856 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHEN P RUSSO Periodontist 312-641-2572 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: IL 019-026457) |
| Enumeration Date | 2006-11-09 |
| Last Update Date | 2020-08-22 |