| NPI | 1366861296 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MAUREEN SEVANDAL Member 312-493-6102 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry (Licence: IL 019.026706) |
| Additional Taxonomies | 1223P0221X Dentist Pediatric Dentistry (Licence: IL 019026649) |
| Enumeration Date | 2014-04-08 |
| Last Update Date | 2014-04-08 |