| NPI | 1346441219 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FLOR D. LOYA-COSTABILE President 708-344-5437 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IL 019022347) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: IL 021001646) |
| Enumeration Date | 2007-05-30 |
| Last Update Date | 2020-08-22 |