| NPI | 1366975419 |
|---|---|
| Doing Business As | 162ND STREET DENTAL |
| Entity Type | Organization |
| Authorized Contact | SAMUEL OSOBU President 312-493-6089 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center Dental (Licence: IL 019030498) |
| Enumeration Date | 2017-04-06 |
| Last Update Date | 2017-04-06 |