| NPI | 1336710540 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DORINA NASTASE Member 773-698-5773 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice |
| Additional Taxonomies | 261QD0000X Clinic/Center Dental |
| Enumeration Date | 2021-07-08 |
| Last Update Date | 2025-08-06 |