| NPI | 1407146574 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DARREN PAKRAVAN Owner 773-697-8038 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2011-04-11 |
| Last Update Date | 2011-04-11 |