| NPI | 1356749550 |
|---|---|
| Doing Business As | WICKER PARK DENTAL GROUP |
| Entity Type | Organization |
| Authorized Contact | KRISHNA M GOPISETTY President 773-276-5566 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IL 019029636) |
| Enumeration Date | 2014-12-21 |
| Last Update Date | 2014-12-21 |