| NPI | 1346772043 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LIBORIO PADULA Director 773-424-6401 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: IL 021002476) |
| Enumeration Date | 2017-03-31 |
| Last Update Date | 2017-03-31 |