| NPI | 1376790378 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LORENA LEMAIRE Dentist 312-738-1701 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: IL 019025681) |
| Enumeration Date | 2008-08-20 |
| Last Update Date | 2008-08-20 |