| NPI | 1417134131 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GEORGE COLONE Club Director 773-271-8400 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: IL 021002250) |
| Enumeration Date | 2008-01-24 |
| Last Update Date | 2008-01-24 |