| NPI | 1447568977 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUE PELLETIER Admin Assistance 773-577-2100 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: IL 021-000547) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IL 019-020397) |
| Enumeration Date | 2010-09-17 |
| Last Update Date | 2010-09-17 |