| NPI | 1366969495 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL L CONNOLLY Owner 773-286-9700 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: IL 019020342) |
| Enumeration Date | 2017-08-29 |
| Last Update Date | 2017-08-29 |